Clinical Associate Professor, Emergency Medicine
Clinical Assistant Professor, Pediatrics
Boards, Advisory Committees, Professional Organizations
Chair-Pediatric Emergency Medicine Section, American College of Emergency Physicians (2017 - Present)
Fellow, American College of Emergency Physicians (2016 - Present)
ACEP Pediatric Section Officer, American College of Emergency Physicians (2008 - Present)
Fellow, American Academy of Pediatrics (2015 - Present)
Community and International Work
Co-Director, Palo Alto, California
Advanced Emergency Medicine High School Program
High School Students
Opportunities for Student Involvement
Current Research and Scholarly Interests
Use of telepresence technologies can improve efficiencies where geographic and temporal preclude in person interaction. Specifically, at our institution, our emergency department is located in a physically separate location from our pediatric hospitals. We utilize two separate hospitals for our pediatric admissions staffed by hospitalists that are within a different medical system. Because of this, it can be cumbersome to directly communicate for admissions, consults, and transfers.
We have implemented a telemedicine platform with a standardized workflow to help alleviate the issues surrounding our specific idiosyncrasies. Current research focuses on error reduction, efficiency, provider satisfaction, and patient satisfaction.
Technological advances in 360 video recording and playback have reached a point where the medium can be effectively implemented as a training platform.
We have used a 360 degree camera to film patient vignettes. Specifically, we filmed high school students after a "mass casualty" shooting event. Each patient vignette involved a specific injury requiring a specific triage level and intervention.
We took these filmed segments and added a graphical user interface that prompted a user to choose a triage level and intervention.
Users were placed in VR goggles and watched each vignette and had to choose a triage level and intervention based on what they viewed. They were scored based on correctly choosing the triage level and intervention.
Future projects will be based on workplace violence and trauma protocols.
Emergency Department Access During COVID-19: Disparities in Utilization by Race/Ethnicity, Insurance, and Income
Western Journal of Emergency Medicine
In March 2020, shelter-in-place orders were enacted to attenuate the spread of coronavirus 2019 (COVID-19). Emergency departments (EDs) experienced unexpected and dramatic decreases in patient volume, raising concerns about exacerbating health disparities.We queried our electronic health record to describe the overall change in visits to a two-ED healthcare system in Northern California from March-June 2020 compared to 2019. We compared weekly absolute numbers and proportional change in visits focusing on race/ethnicity, insurance, household income, and acuity. We calculated the z-score to identify whether there was a statistically significant difference in proportions between 2020 and 2019.Overall ED volume declined 28% during the study period. The nadir of volume was 52% of 2019 levels and occurred five weeks after a shelter-in-place order was enacted. Patient demographics also shifted. By week 4 (April 5), the proportion of Hispanic patients decreased by 3.3 percentage points (pp) (P = 0.0053) compared to a 6.2 pp increase in White patients (P = 0.000005). The proportion of patients with commercial insurance increased by 11.6 pp, while Medicaid visits decreased by 9.5 pp (P < 0.00001) at the initiation of shelter-in-place orders. For patients from neighborhoods <300% federal poverty levels (FPL), visits were -3.8 pp (P = 0.000046) of baseline compared to +2.9 pp (P = 0.0044) for patients from ZIP codes at >400% FPL the week of the shelter-in-place order. Overall, 2020 evidenced a consistently elevated proportion of high-acuity Emergency Severity Index (ESI) level 1 patients compared to 2019. Increased acuity was also demonstrated by an increase in the admission rate, with a 10.8 pp increase from 2019. Although there was an increased proportion of high-acuity patients, the overall census was decreased.Our results demonstrate changing ED utilization patterns circa the shelter-in-place orders. Those from historically vulnerable populations such as Hispanics, those from lower socioeconomic areas, and Medicaid users presented at disproportionately lower rates and numbers than other groups. As the pandemic continues, hospitals should use operations data to monitor utilization patterns by demographic, in addition to clinical indicators. Messaging about availability of emergency care and other services should include vulnerable populations to avoid exacerbating healthcare disparities.
View details for DOI 10.5811/westjem.2021.1.49279
- Critical Decisions in Emergency Medicine-Dangerous Curves American College of Emergency Physicians. 2018 17–25