Clinical Focus

  • Internal Medicine
  • Hospital Medicine

Academic Appointments

  • Clinical Associate Professor, Medicine

Administrative Appointments

  • MSPA Advisory Committee, Stanford (2023 - Present)
  • Chief Medical Officer, Stanford Health Care Tri-Valley (2017 - Present)
  • SHC TV Strategic Planning: Research and Education Co-Lead, Stanford Health Care Tri-Valley (2019 - 2020)
  • SHC TV Strategic Planning: Branding and Marketing Workgroup, Stanford Health Care Tri-Valley (2019 - 2020)
  • Systems Referrals - Committee Co-Chair, Stanford Health Care Tri-Valley (2018 - 2020)
  • Clinical Assistant Professor A&P Committee, Stanford University (2022 - Present)
  • Medical Director Hospitalist Team, Stanford Health Care Tri-Valley (2015 - 2017)
  • Ambulatory Network Optimization Task Force, Stanford Health Care (2018 - 2020)
  • Academic University Hospitalist, Stanford Hospital - Palo Alto (2012 - Present)
  • Faculty Mentor, Core Faculty Mentoring Program (2013 - 2018)
  • Director, Medicine Consult / Procedure Team Rotation (2013 - 2017)
  • High Value Care Representative, Stanford HealthCare (2017 - 2018)
  • Member, SHC Bylaws Committee (2015 - 2016)
  • Member, Department of Medicine Quality Council (2013 - 2015)
  • Medicine SIP, Stanford Hospital (2014 - 2015)

Honors & Awards

  • 2024 SMCI Quality Improvement Symposium - Multi-Disciplinary Winner, SMCI (2024)
  • 2024 SMCI Quality Improvement Symposium - High Value Winner, SMCI (2024)
  • SMCI QI Symposium - Innovation Winner, SMCI (2024)
  • Empowering Patients: After-Visit Summary Education to Reduce Skilled Nursing Facility Readmissions, Honorable Mention - Stanford QIPSS (Cameron Ehsan, Nathan Kim, Arman Sharma, David Svec,Lisa Shieh) (5/2023)
  • Feasibility Grants to Advance Graduate Medical Education in California, Tides Foundation Grant (2021)
  • Cost Savings Reinvestment Program - Certificate of Achievement, Stanford Health Care (2020)
  • ISP Star Award 2020 - Network Access Optimization Team, Stanford Health Care (2020)
  • Melinda Mitchell Quality Award, Stanford Health Care - ValleyCare - Telestroke program (2019)
  • Stupski Planning Grant Recipient, Stanford Health Care - ValleyCare (2019)
  • Melinda Mitchell Quality Award, Stanford Health Care (2018)
  • David A. Rytand Clinical Teaching Award, Stanford University - Department of Medicine (2016)
  • Lawrence Mathers Award:Exceptional Commitment to Teaching / Active Involvement in Medical Student Ed, Stanford School of Medicine (2016)
  • VPTL Grant, Stanford University (2016)
  • Arthur L. Bloomfield Award for Excellence in Clinical Teaching, Stanford University Medical School (2014)
  • David A. Rytand Clinical Teaching Award, Stanford University - Department of Medicine (2014)
  • Medical Honor Society, Alpha Omega Alpha (2009)
  • Business Honor Society, Beta Gamma Sigma (2009)

Boards, Advisory Committees, Professional Organizations

  • SHC-VC, Network Development Committee (2019 - 2021)
  • Board Member, Quest Science Center (2024 - Present)
  • SHC-VC, CORT (Clinical Oversight Resource Team) COVID (2019 - 2021)
  • Member, Society of Hospital Medicine (2013 - 2014)
  • Participant, Clinical Effectiveness Leadership Training (2018 - 2019)
  • Participant, Stanford Leadership Development Program (2014 - 2015)

Professional Education

  • Residency: Stanford University Internal Medicine Residency (2012) CA
  • Medical Education: Case Western Reserve School of Medicine (2009) OH
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2012)
  • MBA, Case Western Reserve University - Weatherhead School of Management (2009)
  • BA, University of Notre Dame, Economics - Pre-Medical Studies

Contact

  • Clinical (Primary)  Hospitalist for Stanford Medical Center 500 Pasteur Dr Stanford, CA 94305 (650) 498-4649 (fax)

Additional Clinical Info

Links

Current Research and Scholarly Interests

High Value Care: Leading quality improvement projects / research initiatives

Projects

  • Cost Savings Reinvestment Program, Stanford Health Care (2017 - 2019)

    The Appropriate Use of Accommodations Project – Level of Care
    Instituted two Best Practice Alerts and recruited faculty champions throughout hospital to drive value at Stanford HealthCare

    Location

    Stanford California

  • Clinical Excellence Research Center - AIM project, Clinical Excellence Research Center (2014)

    Assisted in developing data collection tools to explore relative efficiency and quality between health groups. Developed interview guides and/or questionnaires using clinical scenarios to explore care delivery models and practice patterns for Interventional Cardiology, General Cardiology and Nephrology.
    Site Visit Lead: University of Alabama Site Visit

    Location

    94304

  • Stanford Healthcare Consulting Group - Observation Status: Denial of Admissions and Reimbursement (2013 - 2014)

    Hospital Mentor for SHCG: Understand implications of miscategorization “observation status” vs. “inpatient.” The project quantified the rate of patient miscategorization, modeled the substantial financial impact of misclassification (for patients and SHC), and developed recommendations to minimize future errors.

    Location

    United States

    Collaborators

  • Stanford Healthcare Consulting Group - Supporting Clinically Appropriate and Cost-effective Lab Test Utilization (2013 - 2014)

    Hospital Mentor for SHCG: Lab test overutilization is a widespread challenge at virtually all medical centers, leading to substantial costs and in some cases, placing patients at risk from unnecessary follow-up tests and procedures. SHCG examined the most commonly-ordered lab tests by cost and volume to evaluate which tests are inappropriately ordered. The team provided reasons for lab test overutilization and prepared evidence-based recommendations to address this problem.

    Location

    United States

    Collaborators

  • Stanford Healthcare Consulting Group - Barriers to Discharge for Clinical High Risk Patients (2014)

    Identified barriers to discharge for clinical high risk patients by recording reasons for delayed discharges through:
    a.Data collection at clinical high risk patient meetings
    b.Interviews of team care members (RNs, case managers, MDs, etc.)
    Examined the primary barriers to discharge and determine how/when they arise.
    a.Stratified by medical unit and patient’s primary medical condition to determine whether barriers may be unique to these factors.
    Assessed the financial burden as a result of delayed discharges.
    Formed recommendations to address these primary barriers to discharge that may be implemented in the immediate future, as well as, in the short term and long term.
    Work Presented at ACP Northern California in November 2014

    Location

    United States

    Collaborators

  • Stanford Healthcare Consulting Group - ED Admissions Project (2013)

    Hospital Mentor for SHCG: The ED Admissions project team has studied emergency room admissions processes and the determinants of patients being admitted to telemetry and non-telemetry beds as well as patients being admitted under inpatient or observation status. By analyzing ED admissions data, conducting a wide range of interviews with key staff and stakeholders, and closely observing ED operations, the team has improved understanding of how admitted patients are currently being placed and developed recommendations for improvement.

    Location

    94304

    Collaborators

  • Practice of Medicine - Preceptors (2012 - Present)

    Practicum preceptors have the opportunity to work with 2 different groups of students teaching history taking skills / physical examination skills.

    Location

    94304

  • Stanford Healthcare Consulting Group - Cost Per Case (2014)

    The University HealthSystem Consortium (UHC) is a data driven collaboration among nonprofit academic medical centers across the nation. The purpose of this alliance is to drive and support better patient care by sharing data to identify areas of improvement in patient outcomes, quality of care and costs. The SHCG group project aims to understand Stanford's cost per case.

    Location

    Stanford Ca

    Collaborators

  • SHIELD: Patient Partners Program (2014)

    A Co-Director of the Patient Partners Program, an innovative longitudinal patient-student service curriculum within SHIELD (Stanford Healthcare Innovations and Experiential Learning Directive)

    Location

    Stanford Ca

    Collaborators

    • Alistair Aaronson, Clinical Assistant Professor, Medicine
  • Stanford Healthcare Consulting Group - Follow-up Scheduling (2015)

    Location

    Stanford Ca

    Collaborators

  • Stanford ValleyCare: Inpatient Rotation - Developer: Internal Medicine Resident, Stanford ValleyCare

    Location

    Pleasanton, Ca

    Collaborators

  • Stanford ValleyCare: Inpatient Rotation - Developer - PA Student Rotation

    Location

    Pleasanton, Ca

    Collaborators

  • Stanford Healthcare Consulting Group - Clinical Decision Unit (2016)

    Location

    Stanford Ca

    Collaborators

  • Smart wearable devices and patient mobility and sleep during acute hospitalization, ACP Poster (2016)

    Location

    stanford california

    Collaborators

  • An Intervention to Reduce Telemetry Use at an Academic Center and Its Impact on Rapid Response Team and Code Events, ACP Poster (2016)

    Location

    Stanford California

    Collaborators

  • Interprofessional Education for 21st Century Care

    Trainees are put into clinical multidisciplinary teams with little knowledge about their non-MD colleagues. Trainees often are not aware of the specialized expertise these healthcare professional team members possess (e.g. social work, case management, nursing, respiratory therapy, and occupational therapy) and are compelled to try to understand the often vague and fraught environment of interdisciplinary hierarchies and team dynamics. This lack of knowledge and training results in confusion and missteps that can lead to patient care errors, poor communication, hostile working conditions, and decreased job satisfaction. Our project will survey interns and allied health professionals to identify knowledge gaps and barriers to inter-professional practice. The information will be used to create teaching videos addressing these gaps, while also stimulating discussion about hierarchies in healthcare, as well as goals of, and potential barriers to, collaboration in practice. Videos will be targeted towards medical students and advanced practice providers, preparing them for inter-professional collaboration when entering practice, clerkships and residencies.

    Location

    Stanford CA

    Collaborators

    • Mariposa Garth-Pelly, School of Medicine
    • Alistair Aaronson, Clinical Assistant Professor, Medicine
  • Stanford Healthcare Consulting Group - Long Length of Stay Evaluation (2017)

    Optimizing length of stay (LOS) was identified as one of the overall Stanford Health Care quality initiatives across all departments. This project involved exploring who the LLOS patients were, the barriers to discharge, the workflow, and recommendations for addressing this important hospital issue

    Location

    Stanford California

    Collaborators

  • Collaborate as a Member of an Interprofessional Team—How can we ensure students are ready?, ACP Abstract

    ACP Abstract

    Location

    Stanford University

    Collaborators

    • Mariposa Garth-Pelly, School of Medicine
    • Alistair Aaronson, Clinical Assistant Professor, Medicine
    • David Svec, Clinical Associate Professor, Medicine
  • Stanford ValleyCare - Hepatology Transfer Project, Stanford (2016 - 2017)

    Location

    Stanford University

    Collaborators

  • Stanford ValleyCare - Vascular Surgery Transfer Project, Stanford University (2016 - 2017)

    Location

    Stanford University

    Collaborators

    • Rudy Arthofer , Stanford HealthCare, SHC
    • Minjoung Go, Clinical Associate Professor, Medicine
  • Stanford Cardiac Monitoring BPA (Best Practice Alert), SHC (2016 - 2017)

    Location

    Stanford University

    Collaborators

  • Stanford ValleyCare Epic Deployment (2017 - 2018)

    Location

    Pleasanton

    Collaborators

    • Weihan Chu, Clinical Assistant Professor, Medicine
  • Stanford ValleyCare: Telestroke/Primary Stroke Center (2018)

    Location

    Pleasanton

    Collaborators

  • A Simple Click: Cost Savings of Best Practice Alerts to Decrease Inappropriate Level of Care Assignments, QIPSS (5/14/2018)

    Jingkun Yang MD [1], Jessica Ferguson MD [1], Surbhi Singhal MD [1], Christopher Sharp MD [1], Benjamin Leung [1], Dale Beatty DNP RN [1], David Svec MD MBA [1], Lisa Shieh MD PhD [1] Abstract for the Resident/Fellow Quality Improvement/Patient Safety Symposium (QIPSS)

    Location

    stanford

    Collaborators

    • Jingkun (Ginger) Yang, Stanford Medicine , Stanford Medicine
    • Christopher Sharp, Medicine - Primary Care and Population Health
    • Lisa Shieh, Clinical Professor, Medicine
  • Rationale and design of the EARLIER* trial: a randomized evaluation of modest monetary incentives to facilitate prompt patient discharge planning, SHC (5/1/2018)

    QI Symposium - Ginger Yang, Lisa Shieh, Bo Wang

    Location

    Stanford

    Collaborators

    • Lisa Shieh, Clinical Professor, Medicine
    • Bo Wang, Medicine
  • Inpatient Length of Stay Increases Due to Consult Delays, Stanford HealthCare (5/1/2018)

    Arifeen S Rahman, AB1; Pamela Meza, BS1; Siyu Shi, BS1; Justin Jia, BS1; David Svec, MD, MBA2; Lisa Shieh, MD, PhD2
    Stanford University School of Medicine1 and Department of Medicine2, Stanford, CA

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Improving O:E Mortality at SHC, Stanford University (1/1/2019)

    Improving O:E Mortality at SHC
    Faculty Leads: Jason Hom / Lisa Shieh / David Svec

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Patient Experience: Quiet at Night/Inpatient Sleep (January 2019)

    Patient Experience: Quiet at Night/Inpatient Sleep
    Faculty Lead: Lisa Shieh / David Svec / Ed Sheen

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - SHC Cost: Limited Echo, Stanford University (January 2019)

    SHC Cost: Limited Echo
    Faculty Lead: Lisa Shieh / David Svec

    Location

    Stanford

    Collaborators

  • Enterprise Contact Center: Stanford HealthCare - ValleyCare - Radiology, Stanford Health Care (June 2018)

    Integration of Stanford HealthCare - ValleyCare - Radiology into the Enterprise Contact Center algorithm.

    Location

    Pleasanton, Ca

    Collaborators

    • Weihan Chu, Clinical Assistant Professor, Medicine
  • Enterprise Contact Center: Stanford HealthCare - ValleyCare - Physical Therapy/Occupational Therapy, Stanford Health Care (September 2018)

    Integration of Stanford HealthCare - ValleyCare - PT/OT into the Enterprise Contact Center algorithm.

    Location

    Pleasanton, Ca

    Collaborators

    • Weihan Chu, Clinical Assistant Professor, Medicine
  • Clinical Effectiveness Leadership Training - Debility Project, Stanford University (2018 - 2019)

    Location

    Stanford

    Collaborators

    • Jason Hom, Clinical Associate Professor, Medicine
    • Nam Bui, Clinical Assistant Professor, Medicine - Oncology
  • Stanford Health Care - ValleyCare: Quiet at Night, Stanford Health Care - ValleyCare (2019)

    Supervised PA student from Touro University to understand Quiet at Night Hospital Compare metric at Stanford Health Care - ValleyCare

    Location

    Pleasanton, Ca

    Collaborators

  • Co-Lead for SHC-ValleyCare Research and Education Strategic Planning Workgroup, Stanford Health Care - ValleyCare (10/2019)

    Location

    Pleasanton, Ca

  • Stanford Healthcare Consulting Group - Guided Journey Project / Inpatient MyHealth, Stanford University (2019)

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Malnutrition CDI, Stanford University (2018 - 2019)

    Malnutrition specificity is consistently one of the top CDI queries at SHC-PA. This can result in missed opportunities for early
    nutritional interventions, impacts on quality and finance metrics.

    Location

    Stanford

    Collaborators

  • NIH Trial: Multicenter, Adaptive, Randomized Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for the Treatment of COVID-19 in Hospitalized Adults, Stanford Health Care - ValleyCare (4/10/2020)

    Investigator

    Location

    Pleasanton, Ca

  • CORT Planning - COVID SHC-VC, Stanford Health Care - ValleyCare (3/1/2020 - Present)

    CORT participant to align COVID response between SHC, SHC-VC, LPCH, and UHA.

    Location

    Pleasanton, Ca

  • SHC-VC Hospital Agreements Intranet Refresh, Stanford Health Care - ValleyCare (1/2020 - Present)

    Updated portal demonstrating hospital call agreements

    Location

    Pleasanton, Ca

  • SHC-VC Physician Agreements, Stanford Health Care - ValleyCare (7/1/2019 - Present)

    Establish and monitor SHC-VC Medical Directorship agreements/Physician Call agreements

    Location

    Pleasanton, Ca

  • Cost Savings Reinvestment Program: Appropriate Magneium Ordering, Stanford University (4/1/2020 - Present)

    Location

    Stanford University

    Collaborators

    • Lisa Shieh, Clinical Professor, Medicine
    • Nicholas Scoulios, Clinical Assistant Professor, Med/Hospital Medicine
    • Jonathan Chen, Assistant Professor, Stanford University
  • Stanford Healthcare Consulting Group - Strategic Planning for Solar Energy Use, Stanford University (4/16/2020 - Present)

    Strategize the use of solar energy for SHC, propose plans for organizational changes and prepare a pitch for the importance of sustainability to leadership.
    Build on existing foundation of SHCG project that identified sustainable practices as a need at SHC
    Collaborate with Stanford University (Stanford Health and Climate Taskforce) and Stanford Healthcare (Director of Sustainability) for solar energy proposal
    Investigate Stanford University strategic reasons for the stock farm solar array
    Evaluate feasibility, use case, methods, benefits, return on investment, etc. of pursuing solar energy

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group -Telemedicine for Inpatient Care at SHC, Stanford University (4/16/2020 - Present)

    The group will compare different short-term and long-term options, evaluate clinical efficacy and cost-effectiveness, and propose a strategic plan and potential business partnerships.
    Evaluate need for telemedicine consults and telemedicine physical exams at SHC, short-term (in the COVID-19 condition) and long-term
    Assess perception by clinicians and hospital patients of potential adoption of new technologies
    Research recent health policy changes and reimbursement changes that impact billing for inpatient care with telemedicine
    Scope out options for telemedicine equipment and technology providers, for both short-term rental and long-term subscriptions

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Reducing inappropriate magnesium ordering within Stanford Hospital, Stanford University (2020 - 2020)

    Reducing inappropriate magnesium ordering within Stanford Hospital (saving Stanford upwards of $1M annually)

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Sustainable Actions for High Value Energy and Efficiency Scoping, Stanford University (2020 - 2020)

    Sustainable Actions for High Value Energy and Efficiency Scoping (Exlpore areas where solar energy can be leveraged across Stanford Medicine/Hospital)

    Location

    Stanford

  • Network Access Optimiazation: Endocrinology (2019 - 2019)

    Redesign Epic interface and creation of single referral queue for Stanford Medicine

    Location

    Stanford

  • Network Access Optimiazation: Primary Care, Stanford University (2019 - 2019)

    To develop a proof of concept and scalable framework to implement a simplified Primary Care referral system:

    Streamline primary care new patient visit types
    Integrate processes to create a common work queue driven by patient preferences
    Increase scheduling visibility across the system by leveraging team scheduling capabilities
    Enable efficient self scheduling and positive user experience

    Location

    Stanford

  • Cost Savings Reinvestment Program - SHC-VC Launch, Stanford Health Care - ValleyCare (2020 - 2020)

    Expaneded Cost Savings Reinvestment Program to SHC-VC

    Location

    Pleasanton, Ca

  • Stanford Healthcare Consulting Group - Family Medicine Program SHC-VC, Stanford Health Care - ValleyCare (2021)

    Stanford Health Care – ValleyCare, a 160+ bed hospital located in Pleasanton, recently completed its 5 year strategic plan. One of the main components listed in the strategic plan is further developing the education and research mission. Stanford Health Care – ValleyCare has succeeded in starting numerous PA and Resident rotations.
    The strategic plan identified the creation of a GME Family Medicine Program as an opportunity for Stanford Health Care – ValleyCare. This project would work directly with the SHC-VC CMO, SHC-VC Academic Physician in Chief and the SHC-VC Medical Director for Education to define the steps and resources needed to launch a new training program.

    Location

    Pleasanton, Ca

    Collaborators

  • Stanford Healthcare Consulting Group - Readmissions - Value Based Care, SHC (2021)

    1 in 5 Medicare beneficiaries is readmitted within 30 days of hospital discharge, incurring a cost of over $26 billion each year (Leppin et al. 2014). Policymakers have identified preventable hospital readmissions as a leading US healthcare problem, reducing reimbursement for hospitals with excess 30-day readmissions (Fontanarosa et al. 2013). In addition to cost savings, reducing readmissions is crucial because rehospitalizations jeopardize the health of elderly patients who are particularly susceptible to hospital-acquired infections and poor outcomes when hospitalized.
    There is increasing evidence that proper transitions of care (TOC) can improve readmissions. The development of the transitionalist program in 2017 was successful in reducing pneumonia readmissions from 22.4% to 10%.
    This project will focus on one DRG on General Medicine. It will look for opportunities to improve the readmission rate for that DRG.

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Magnesium Project, SHC (2020)

    High value care - reducing inappropriate magnesium lab ordering

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Reusable Gowns, Stanford University (2020)

    Sustainability Project - Exploring Reusable Gowns

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Colocation, Stanford University (2020)

    Hospital Medicine Colocation Floor Project

    Location

    Stanford University

    Collaborators

  • Stanford Healthcare Consulting Group - Post Acute Care, Stanford University (2021 - 2021)

    Of all the different healthcare settings in the United States where patients receive care, perhaps the most familiar to us is the hospital setting. However, this is not the setting where patients actually spend most of their recovery time. These settings, where patients go after the hospital, are called post-acute facilities, and they include long term acute care facilities, subacute facilities, and skilled nursing facilities. While these settings are often less understood, by both lay and healthcare professionals alike, they are an incredibly important component of our healthcare infrastructure.
    This project explores the crucial and complex relationships between hospitals and post-acute settings. We will go over definitions, clinical and financial implications for patients, financial and operational implications for hospitals, and innovative ways to spur collaboration that promotes continuity, efficiency, and value.

    Please list expected deliverables:
    Improved understanding of the differences among hospitals, LTACHs, Subacute facilities, and SNFs
    Ability to articulate the financial implications to the hospital in transferring patients to these facilities
    Enhanced appreciation for the importance of relationship building and collaboration with community partners to ensure solvency and sustainability

    Location

    Stanford

    Collaborators

    • Alistair Aaronson, Clinical Assistant Professor, Medicine
  • Stanford Healthcare Consulting Group - Escalation Pathway (2021 - 2021)

    Stanford Health Care has set an operational goal within the Quality, Safety, and Health Equity domain for a 30-day readmission rate of <12% and length of Stay Index of < 0.88. On the Medicine teams, interdisciplinary team (physicians, nursing, therapy services, nutrition, and case management) huddles are critical to arrange care and follow-up to achieve these effectiveness metrics. The interdisciplinary team huddles have changed forms multiple times in the past 5 years. COVID protocols have also influenced the structure of the team huddles with the interdisciplinary team. The SHCG group will assess the current afternoon huddle structure: best practices, opportunities, and successes. The SHCG group will also assess what happens to the information shared and what, and to whom, the information gets escalated if there are delays and / or gaps in care.
    Please list expected deliverables:
    Assessment of the afternoon interdisciplinary team care rounds huddle
    Best practices, opportunities, and successes
    Flow chart of escalation pathways: current vs. desired state

    Location

    Stanford

    Collaborators

  • Stanford Healthcare Consulting Group - Sustainability - Linen Waste, Stanford University (2021)

    The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste "Linen is the last bastion of pure, true savings hospitals can tap into, simply by reducing unnecessary waste," says Jake McCuistion, Executive Vice President of Patient Flow and Linen Utilization Management (LUM) with HHS. "Linen management can be very time consuming, so hospitals have to invest in order to run this kind of program effectively in-house." SHC spends more on linens compared to other medical centers of similar size. It is important to understand the root cause of linen waste so that we can consider other sustainable projects such as relaundered gowns.
    SHC has created a 5 year mission to be a leader in healthcare sustainability.


    Please list expected deliverables:
    Determine the root cause of linen waste at SHC
    Understand current state of linen use and waste
    Discuss with key stakeholders
    Survey healthcare workers on attitudes towards sustainability
    Literature review of best practices
    Recommendations to reduce linen waste

    Location

    Stanford

  • SHC-VC Telepsychiatry Service Evaluation/Implementation, Stanford Health Care - ValleyCare (2020 - 2021)

    Location

    Pleasanton, Ca

  • Stanford Healthcare Consulting Group - LLOS, Stanford Health Care (2023 - 2023)

    Evaluating Escalation Pathway

    Location

    Palo Alto

  • Stanford Healthcare Consulting Group - SHCTV Endocrinology Assessment, Stanford Health Care (2023)

    Assessment of on call service SHCTV ED Endocrinology

    Location

    Palo Alto

  • SHCTV Family Medicine Residency Feasibility Project, Stanford Health Care - Tri-Valley (2022)

    Assessing feasbility of Family Medicine Residency Program at SHCTV

    Location

    Pleasanton

    Collaborators

  • Telemedicine Addiction Medicine Stanford Healthcare Tri-Valley, Stanford Healthcare - Tri-Valley (2024)

    Lead extension of Addiction Medicine to Stanford Healthcare Tri-Valley via telemedicine

    Location

    Pleasanton, California

  • Teledermatology - Stanford Healthcare Tri-Valley, Stanford Healthcare - Tri-Valley (2024)

    Led feasibility assessment and evaluation of teledermatology services for SHCTV

    Location

    Pleasanton, California

  • Stanford Healthcare Consulting Group - Voalte Project, Stanford School of Medicine (3/2024)

    Wellness project focused on Voalte messaging tool - setting physicians as busy status

    Location

    Pleasanton, California

  • Stanford Healthcare Consulting Group - CAUTI Improvement Project, Stanford School of Medicine (3/2024)

    Location

    Pleasanton, California

  • Stanford Healthcare Consulting Group - Quiet at Night, SHCTV (2024)

    Evaluated Quiet at Night at SHCTV and methods to improve

    Location

    Pleasanton, Ca

2024-25 Courses

All Publications

  • Quality improvement project to reduce medicare 1-day write-offs due to inappropriate admission orders. BMC health services research Oke, O., Sullivan, K. M., Hom, J., Svec, D., Weng, Y., Shieh, L. 2024; 24 (1): 204

    Abstract

    We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient's hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs.We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients' inpatient designation prior to discharge and change the patient's designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019.A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review.This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.

    View details for DOI 10.1186/s12913-024-10594-z

    View details for PubMedID 38355492

    View details for PubMedCentralID 6181108

  • Targeting Repetitive Laboratory Testing with Electronic Health Records-Embedded Predictive Decision Support: A Pre-Implementation Study. Clinical biochemistry Rabbani, N., Ma, S. P., Li, R. C., Winget, M., Weber, S., Boosi, S., Pham, T. D., Svec, D., Shieh, L., Chen, J. H. 2023

    Abstract

    INTRODUCTION: Unnecessary laboratory testing contributes to patient morbidity and healthcare waste. Despite prior attempts at curbing such overutilization, there remains opportunity for improvement using novel data-driven approaches. This study presents the development and early evaluation of a clinical decision support tool that uses a predictive model to help providers reduce low-yield, repetitive laboratory testing in hospitalized patients.METHODS: We developed an EHR-embedded SMART on FHIR application that utilizes a laboratory test result prediction model based on historical laboratory data. A combination of semi-structured physician interviews, usability testing, and quantitative analysis on retrospective laboratory data were used to inform the tool's development and evaluate its acceptability and potential clinical impact.KEY RESULTS: Physicians identified culture and lack of awareness of repeat orders as key drivers for overuse of inpatient blood testing. Users expressed an openness to a lab prediction model and 13/15 physicians believed the tool would alter their ordering practices. The application received a median System Usability Scale score of 75, corresponding to the 75th percentile of software tools. On average, physicians desired a prediction certainty of 85% before discontinuing a routine recurring laboratory order and a higher certainty of 90% before being alerted. Simulation on historical lab data indicates that filtering based on accepted thresholds could have reduced 22% of repeat chemistry panels.CONCLUSIONS: The use of a predictive algorithm as a means to calculate the utility of a diagnostic test is a promising paradigm for curbing laboratory test overutilization. An EHR-embedded clinical decision support tool employing such a model is a novel and acceptable intervention with the potential to reduce low-yield, repetitive laboratory testing.

    View details for DOI 10.1016/j.clinbiochem.2023.01.002

    View details for PubMedID 36623759

  • A Prioritization Model for Emergency Telepsychiatry Service Evaluation and Selection TELEHEALTH AND MEDICINE TODAY Sandling, J., Carrothers, K., Svec, D. 2023; 8 (3)
  • Wolfe, C. Tomashek, K. et. al. ACTT Study group (includes Svec, D.). Baricitinib versus dexamethasone for adults hospitalised with COVID-19 (ACTT-4): a randomised, double-blind, double placebo-controlled trial. Lancet Respiratory Medicine. 9/2022; 10(9):888-899. doi: PMID: 35617986. Lancet Respiratory Medicine Wolfe, C. 2022
  • Physicians Leading Physicians: A Physician Engagement Intervention Decreases Inappropriate Use of IICU Level of Care Accommodations. American journal of medical quality : the official journal of the American College of Medical Quality Ruiz Colón, G. n., Yang, J. n., Svec, D. n., Heidenreich, P. n., Britt, P. n., Smith, M. n., Sharp, C. n., Shieh, L. n. 2021

    Abstract

    Following the adoption of an acuity-adaptable unit model in an academic medical center, a $13M increase in cost of intermediate intensive care unit (IICU) accommodations was observed. The authors followed A3 methodology to determine the root cause of this increase and developed a 3-prong intervention centered on physician engagement, given that physicians have the ability to order a patient's level of care. This intervention consisted of: (1) identifying physician champions to promote appropriate IICU use, (2) visual changes to essential electronic medical record tools, and (3) data-driven feedback to physician champions. In the year following intervention deployment, average IICU length of stay decreased from 1.08 to 0.62 days and average IICU use decreased from 21.4% to 12.3%, corresponding to ~$5.7M cost savings with no significant change in balancing measures observed. Together, these results demonstrate that a multicomponent intervention aimed at engaging physicians reduced inappropriate IICU use with no increase in adverse events.

    View details for DOI 10.1097/01.JMQ.0000735480.43566.f9

    View details for PubMedID 33883423

  • Efficacy of interferon beta-1a plus remdesivir compared with remdesivir alone in hospitalised adults with COVID-19: a double-bind, randomised, placebo-controlled, phase 3 trial The Lancet, Respiratory Medicine Kalil, A. 2021
  • E-HeaRT BPA: electronic health record telemetry BPA. Postgraduate medical journal Chin, K. K., Svec, D. n., Leung, B. n., Sharp, C. n., Shieh, L. n. 2020

    Abstract

    Ccontinuous cardiac monitoring in non-critical care settings is expensive and overutilised. As such, it is an important target of hospital interventions to establish cost-effective, high-quality care. Since inappropriate telemetry use was persistently elevated at our institution, we devised an electronic best practice alert (BPA) and tested it in a randomised controlled fashion.Between 4 March 2018 and 5 July 2018 at our 600-bed academic hospital, all non-critical care patients who had at least one telemetry order were randomised to the control or intervention group. The intervention group received daily BPAs if telemetry was active.275 and 283 patients were randomised to the intervention and control groups, respectively. The intervention group triggered 1042 alerts and trended toward fewer telemetry days (3.8 vs 5.0, p=0.017). The intervention group stopped telemetry 31.7% of the alerted patient-days compared with 23.3% for the control group (OR 1.53, 95% CI 1.24 to 1.88, p<0.001). There were no significant differences in length of stay, rapid responses, code blues, or mortality between the two groups.Using a randomised controlled design, we show that BPAs significantly reduce telemetry without negatively affecting patient outcomes. They should have a role in promoting high-value telemetry use.

    View details for DOI 10.1136/postgradmedj-2019-137421

    View details for PubMedID 32467108

  • Remdesivir for the Treatment of Covid-19 — Preliminary Report The New England Journal of Medicine; Supplemental Appendix: Stanford University, Stanford, CA. Neera Ahuja, MD; Kari Nadeau, MD, PhD, David Svec, MD, MBA, Jessie Kittle, MD, Nidhi Rohatgi, MD, MS, Jeff Chi, MD, Evelyn Ling, MD, Minjoung Go, MD, Sharon Chinthrajah, MD, Jasmine LaCoursiere, MS, Brynn Kron, Ansia Boumis, Leonard Basobas, MS, Ziuyan He, PhD, Jessica Fitzpatrick, Tina Dominguez, PA. Beigel, . 2020
  • Reducing Telemetry Use Is Safe: A Retrospective Analysis of Rapid Response Team and Code Events After a Successful Intervention to Reduce Telemetry Use AMERICAN JOURNAL OF MEDICAL QUALITY Xie, L., Garg, T., Svec, D., Hom, J., Kaimal, R., Ahuja, N., Barnes, J., Shieh, L. 2019; 34 (4): 398–401

    View details for DOI 10.1177/1062860618805189

    View details for Web of Science ID 000476540300012

  • Waiting it out: consultation delays prolong in-patient length of stay. Postgraduate medical journal Rahman, A. S., Shi, S., Meza, P. K., Jia, J. L., Svec, D., Shieh, L. 2019

    Abstract

    Decreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.To quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.We conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.During the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.This report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.

    View details for DOI 10.1136/postgradmedj-2018-136269

    View details for PubMedID 30674619

  • A long wait: barriers to discharge for long length of stay patients. Postgraduate medical journal Zhao, E. J., Yeluru, A., Manjunath, L., Zhong, L. R., Hsu, H., Lee, C. K., Wong, A. C., Abramian, M., Manella, H., Svec, D., Shieh, L. 2018

    Abstract

    INTRODUCTION: Reducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.METHODS: We conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.RESULTS: Discharge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.CONCLUSION: Together with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

    View details for PubMedID 30301835

  • Reducing Telemetry Use is Safe: A Retrospective Analysis of Rapid Response Team and Code Events After a Successful Intervention to Reduce Telemetry Use American Journal of Medical Quality Lijia, X., Svec, D., Hom, J., Ahuja, N., Garg, T., Kaimal, R., Barnes, J., Shieh, L. 2018
  • Evolving Medical Education for a Digital Future Connie, C., David, S., Jonathan, C. Medscape. 2018
  • Barriers to timely discharge from the general medicine service at an academic teaching hospital. Postgraduate medical journal Ragavan, M. V., Svec, D., Shieh, L. 2017

    Abstract

    Reducing delays for patients who are safe to be discharged is important for minimising complications, managing costs and improving quality. Barriers to discharge include placement, multispecialty coordination of care and ineffective communication. There are a few recent studies that describe barriers from the perspective of all members of the multidisciplinary team.To identify the barriers to discharge for patients from our medicine service who had a discharge delay of over 24 hours.We developed and implemented a biweekly survey that was reviewed with attending physicians on each of the five medicine services to identify patients with an unnecessary delay. Separately, we conducted interviews with staff members involved in the discharge process to identify common barriers they observed on the wards.Over the study period from 28 October to 22 November 2013, out of 259 total discharges, 87 patients had a delay of over 24 hours (33.6%) and experienced a total of 181 barriers. The top barriers from the survey included patient readiness, prolonged wait times for procedures or results, consult recommendations and facility placement. A total of 20 interviews were conducted, from which the top barriers included communication both between staff members and with the patient, timely notification of discharge and lack of discharge standardisation.There are a number of frequent barriers to discharge encountered in our hospital that may be avoidable with planning, effective communication methods, more timely preparation and tools to standardise the discharge process.

    View details for DOI 10.1136/postgradmedj-2016-134529

    View details for PubMedID 28450581

  • A High Value Care Curriculum for Interns: A Description of Curricular Design, Implementation and Housestaff Feedback. Postgraduate Medical Journal Hom, J., Kumar, A., Evans, K., Svec, D., Richman, I., Fang, D., Smeralgio, A., Holubar, M., Johnson, T., Shah, N., Renault, C., Witteles, R., Ahuja, N., Harman, S., Shieh, L. 2017
  • Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD) EDUCATION FOR PRIMARY CARE Lin, S., Osborn, K., Sattler, A., Nelligan, I., Svec, D., Aaronson, A., Schillinger, E. 2017; 28 (3): 180–84

    View details for DOI 10.1080/14739879.2016.1259965

    View details for Web of Science ID 000441840100011

  • Physicians and blocking: can we tear down this wall? Postgraduate medical journal Wang, B. n., Svec, D. n. 2017

    View details for PubMedID 28814572

  • Interprofessional Collaboration: A Qualitative Studyof Non-Physician Perspectives on Resident Competency Interprofessional Collaboration: A Qualitative Studyof Non-Physician Perspectives on Resident Competency Garth, M., Millet, A., Shearer, E., Stafford, S., Merrell, S. B., Bruce, J., Schillinger, E., Aaronson, A., Svec, D. 2017
  • Hospitalist intervention for appropriate use of telemetry reduces length of stay and cost JOURNAL OF HOSPITAL MEDICINE Svec, D., Ahuja, N., Evans, K. H., Hom, J., Garg, T., Loftus, P., Shieh, L. 2015; 10 (9): 627-632

    View details for DOI 10.1002/jhm.2411

    View details for Web of Science ID 000360836000012

  • The effect of dehydroepiandrosterone on Zucker rats selected for fat food preference Physiology & Behavior Pham J, Porter J, Svec D, Eiswirth C, Svec F. 2000; 70 (5): 431-41