Clinical Instructor, Pediatrics - General Pediatrics
Residency: Stanford University Pediatric Residency at Lucile Packard Children's Hospital (2022) CA
Medical Education: University of Arizona College of Medicine (2019) AZ
Residency, Stanford University, Pediatrics
Medical Education, University of Arizona (2019)
Undergraduate, University of Arizona Honors College, Bachelor of Science in Health Science, Physiology; Creative Writing, Poetry Emphasis (2015)
Quality Improvement Analyses Revealed a Hidden Shift Following a Retrospective Study on Breastfeeding Rates.
Pediatric quality & safety
2020; 5 (5): e347
Factors affecting exclusive breastfeeding rates are complex. Evaluations for early-onset sepsis can negatively impact breastfeeding success. We sought to determine whether implementing an algorithm utilizing the sepsis risk score (SRS) in chorioamnionitis-exposed newborns would increase exclusive breastfeeding rates. We collaborated with healthcare systems experts to analyze and understand our outcomes.We describe a retrospective cohort study of chorioamnionitis-exposed newborns 35 weeks and older gestation in the Mother-Baby Unit at our institution following a quality improvement project that implemented an SRS algorithm. We compared exclusive breastfeeding rates over 2 time periods, 33 months before and 15 months after SRS algorithm implementation. We completed bivariate comparisons using chi-square and Mann-Whitney U tests to understand the factors contributing to exclusive breastfeeding rates. In a secondary analysis, breastfeeding rates and demographic patterns were examined using p-charts.Following algorithm implementation, exclusive breastfeeding rates increased from 49% to 58% (P = 0.10) in chorioamnionitis-exposed newborns. Factors associated with increased exclusive breastfeeding included Caucasian race, English as the primary language, private insurance, vaginal delivery, and positive group B Streptococcus status. In the secondary analysis, the proportion of non-Hispanic mothers increased from 63% to 80% during the study.Despite SRS implementation, exclusive breastfeeding rates increased but not significantly, and certain sociodemographic factors remain associated with exclusive breastfeeding. Secondary analysis revealed an overall demographic shift affecting the dataset, highlighting the importance of thorough data analysis when evaluating a quality improvement project.
View details for DOI 10.1097/pq9.0000000000000347
View details for PubMedID 34616963
View details for PubMedCentralID PMC8487780
Implementation of the sepsis risk score for chorioamnionitis-exposed newborns.
Journal of perinatology : official journal of the California Perinatal Association
2018; 38 (11): 1581-1587
To prevent early onset sepsis (EOS), ~10% of neonates receive antibiotics based on CDC recommendations regarding chorioamnionitis exposure. A sepsis risk score (SRS) predicts EOS and spares unnecessary evaluation and treatment.Chorioamnionitis-exposed neonates utilize significant resources.An SRS algorithm was implemented to decrease resource utilization in chorioamnionitis-exposed neonates ≥35 weeks'. Outcome measures included antibiotic exposure, time in NICU, laboratory evaluations, and length of stay (LOS). Balancing measures were missed cases of EOS and readmissions. Data were assessed using run charts.Plan-Do-Study-Act cycles were utilized to process map, implement and reinforce the algorithm.A number of 356 patients met inclusion criteria. After algorithm implementation, antibiotic exposure reduced from 95 to 9%, laboratory evaluation from 96 to 22%, NICU observation from 73 to 10%. LOS remained unchanged. No missed cases of EOS, nor sepsis readmissions.Algorithm implementation decreased antibiotic and resource utilization without missing cases of EOS.
View details for DOI 10.1038/s41372-018-0207-7
View details for PubMedID 30158677
Utility of three-dimensional models in resident education on simple and complex intracardiac congenital heart defects.
Congenital heart disease
2018; 13 (6): 1045-1049
Applications of three-dimensional (3D) printed models in medicine include preprocedure planning, patient education, and clinical training. Reproducing complex anatomy as a 3D printed model can be useful for understanding congenital heart defects (CHD). We hypothesized that using 3D printed models during didactic sessions with resident physicians will improve trainees' understanding of CHD.We performed a prospective, randomized educational intervention for teaching pediatric and pediatric/emergency medicine residents about simple (ventricular septal defect [VSD]) and moderately complex (tetralogy of Fallot [ToF]) CHD. Residents were divided into two groups: intervention and control. Each group completed a subjective survey about their comfort with the anatomy, evaluation, and treatment of VSD and ToF and took an objective test on VSD and ToF. They separately received the same 20 min lecture, including projected two-dimensional digital images of VSD and ToF; the intervention group was given 3D printed models created using the same imaging data. After the lecture, the groups repeated the survey and test questions.Twenty-six residents participated in the VSD session, 34 in the ToF. There were no differences in demographics between control and intervention groups. All residents had higher subjective comfort with VSD and ToF after the lectures. There was no difference in baseline test scores for VSD or ToF groups. The control group scored higher on the VSD postlecture test. The intervention group scored higher on the ToF postlecture test.Incorporation of 3D printed models into lectures about CHD imparts a greater acute level of understanding, both subjective and objective, for pediatric and combined pediatric/emergency medicine residents. There does not seem to be an added benefit for understanding ventricular septal defects, but there is for tetralogy of Fallot, likely due to increased complexity of the lesion and difficulty visualizing spatial relationships in CHD with multiple components.
View details for DOI 10.1111/chd.12673
View details for PubMedID 30230245
- Anatomy of a Physiology Major PHYSIOLOGY 2015; 30 (4): 256-257