Clinical Focus

  • Emergency Medicine
  • Emergency Department operations
  • Digital Health
  • Quality Improvement
  • Patient safety
  • Health Care Management

Academic Appointments

Administrative Appointments

  • Associate Chief Quality Officer/Patient Safety Officer, Stanford Health Care (2019 - Present)
  • Vice Chair, Clinical Operations & Quality, Stanford University School of Medicine (2017 - Present)
  • Fellowship Director, EM Administration Fellowship (2015 - Present)
  • Medical Director, Emergency Medicine (2014 - 2017)

Boards, Advisory Committees, Professional Organizations

  • Member, Society of Academic Emergency Medicine Fellowship Committee (2016 - Present)
  • Member, Society of Academic Emergency Medicine (2015 - Present)
  • Fellow, American College of Emergency Physicians (2008 - Present)
  • Board Certified, American Board of Emergency Medicine (2006 - Present)
  • Member, American College of Emergency Physicians (2006 - Present)

Professional Education

  • Residency: Beth Israel Deaconess Medical Center (2005) MA
  • Internship: Beth Israel Deaconess Medical Center (2003) MA
  • Medical Education: UCLA David Geffen School Of Medicine Registrar (2002) CA
  • MBA, Anderson School of Management at UCLA (2002)
  • BS, Stanford University, Biology, with Honors (1995)

Current Research and Scholarly Interests

Emergency Department process improvement
Digital Health
ED operations
ED innovations

All Publications

  • A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology Joshi, R. P., Pejaver, V., Hammarlund, N. E., Sung, H., Lee, S. K., Furmanchuk, A., Lee, H. Y., Scott, G., Gombar, S., Shah, N., Shen, S., Nassiri, A., Schneider, D., Ahmad, F. S., Liebovitz, D., Kho, A., Mooney, S., Pinsky, B. A., Banaei, N. 2020; 129: 104502


    Testing for COVID-19 remains limited in the United States and across the world. Poor allocation of limited testing resources leads to misutilization of health system resources, which complementary rapid testing tools could ameliorate.To predict SARS-CoV-2 PCR positivity based on complete blood count components and patient sex.A retrospective case-control design for collection of data and a logistic regression prediction model was used. Participants were emergency department patients > 18 years old who had concurrent complete blood counts and SARS-CoV-2 PCR testing. 33 confirmed SARS-CoV-2 PCR positive and 357 negative patients at Stanford Health Care were used for model training. Validation cohorts consisted of emergency department patients > 18 years old who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California (41 PCR positive, 495 PCR negative), Seattle, Washington (40 PCR positive, 306 PCR negative), Chicago, Illinois (245 PCR positive, 1015 PCR negative), and South Korea (9 PCR positive, 236 PCR negative).A decision support tool that utilizes components of complete blood count and patient sex for prediction of SARS-CoV-2 PCR positivity demonstrated a C-statistic of 78 %, an optimized sensitivity of 93 %, and generalizability to other emergency department populations. By restricting PCR testing to predicted positive patients in a hypothetical scenario of 1000 patients requiring testing but testing resources limited to 60 % of patients, this tool would allow a 33 % increase in properly allocated resources.A prediction tool based on complete blood count results can better allocate SARS-CoV-2 testing and other health care resources such as personal protective equipment during a pandemic surge.

    View details for DOI 10.1016/j.jcv.2020.104502

    View details for PubMedID 32544861

  • A Body Bag Can Save Your Life: A Novel Method of Cold Water Immersion for Heat Stroke Treatment A Body Bag Can Save Your Life: A Novel Method of Cold Water Immersion for Heat Stroke Treatment Kim, D. A., Lindquist, B. D., Shen, S. H., Wagner, A. M., Lipman, G. S. 2020: 4

    View details for DOI 10.1002/emp2.12007

  • Patient safety and quality outcomes for ED patients admitted to alternative care area inpatient beds. The American journal of emergency medicine Lee, M. O., Arthofer, R., Callagy, P., Kohn, M. A., Niknam, K., Camargo, C. A., Shen, S. 2019


    BACKGROUND: Inpatient hallway beds are one solution to mitigate emergency department (ED) crowding due to boarding of admitted patients. Alternative Care Areas (AltCA) beds are located in inpatient hallways, cardiac catheterization lab, and endoscopy. We examined whether AltCA beds were associated with increased risk of patient safety and quality outcomes: transfer to Intensive Care Unit (ICU), mortality, hospital-acquired infections (HAI), falls, and 72-hour hospital readmission.METHODS: Retrospective cohort study of patients age >18 years admitted from the ED to non-ICU beds at an urban, academic hospital. AltCA bed exclusion criteria: dementia, frequent respiratory interventions, contact or airborne isolation, psychiatric admission, and inability to ambulate. The study periods were: pre-intervention 9/1/2014-3/31/2015, transition 9/1/2015-3/31/2016, and post-intervention 9/1/2016-3/31/2017. Data analysis used unadjusted and multivariable analyses which controlled for age, sex, race, ethnicity, insurance, ED triage Emergency Service Index (ESI) level, and telemetry order.RESULTS: The study included 16,801 patients, with 622 (3.7%) patients in AltCA beds. AltCA beds had younger patients than standard inpatient beds, 57.7 years and 61.7 years; fewer telemetry order, 48.4% and 59.3%; and fewer ESI level 2, 16.1% and 26.2%. AltCA beds had shorter hospital LOS than standard inpatient beds, 2.7 days and 3.4 days. AltCA beds had decreased risk of transfer to ICU -10.6 (95%CI: -18.3, -2.8) and HAI -13.4 (95%CI: -20.3, -6.5) compared to standard inpatient beds.CONCLUSION: Patients in AltCA beds did not have increased risk of patient safety and quality outcomes but rather decreased risk of transfer to ICU and HAI than standard inpatient beds.

    View details for PubMedID 31085010

  • Design and Implementation of a Novel Acute Stroke Code for the Extended Window of Endovascular Treatment Legault, C., Dujari, S., Shen, S. H., Wagner, A. M., Albers, G., Bernier, E., Callagy, P., Vora, N. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Introduction of a Horizontal and Vertical Split Flow Model of Emergency Department Patients as a Response to Overcrowding. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association Wallingford, G., Joshi, N., Callagy, P., Stone, J., Brown, I., Shen, S. 2017


    ED overcrowding is an issue that is affecting every emergency department and every hospital. The inability to maintain patient flow into and out of the emergency department paralyzes the ability to provide effective and timely patient care. Many solutions have been proposed on how to mitigate the effects of ED overcrowding. Solutions involve either hospital-wide initiatives or ED-based solutions. In this article, the authors seek to describe and provide metrics for a patient flow methodology that targets ESI 3 patients in a vertical flow model.In the Stanford Emergency Department, a vertical flow model was created from existing ED space by removing fold-down horizontal stretchers and replacing them with multiple chairs that allowed for assessment and medical management in an upright sitting position. The model was launched and sustained through frequent interdisciplinary huddles, detailed inclusion and exclusion criteria, scripted text on how to promote the flow model to patients, and close analytics of metrics. Metrics for success included patient length of stay (LOS) for those triaged to the vertical flow area compared with ESI 3 patients triaged to the traditional emergency department as a comparison group. The secondary outcome is the total number of patients seen in the vertical flow area. This was a 6-month-September 2014, to February 2015-retrospective pre- and postintervention study that examined LOS as a marker for effective launch and implementation of a vertical patient workflow model.The patients triaged to the vertical flow area in the study period tended to be younger than in the control period (43 years versus 52 years, P = 0.00). There was a significant decrease in our primary end point: the total LOS for ESI 3 patients triaged to the vertical flow area (270 minutes versus 384 minutes, P = 0.00).Implementation of a vertical patient flow strategy can decrease LOS for the vertical ESI 3 patients based upon the inclusion and exclusion criteria. Furthermore, this is accomplished with minimal financial investment within the physical constraints of an existing emergency department.

    View details for DOI 10.1016/j.jen.2017.10.017

    View details for PubMedID 29169818

  • Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction. journal of nursing administration Kane, M., Chui, K., Rimicci, J., Callagy, P., Hereford, J., Shen, S., Norris, R., Pickham, D. 2015; 45 (9): 429-434


    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

    View details for DOI 10.1097/NNA.0000000000000228

    View details for PubMedID 26252725

  • Arthrocentesis of the Knee (Videos in Clinical Medicine) Arthrocentesis of the Knee Thomsen, T. W., Shen, S., et al 2006; e19: 354

    View details for DOI 10.1056/NEJMvcm051914