- Emergency Medicine
- Emergency Department operations
- Digital Health
- Quality Improvement
- Patient safety
- Health Care Management
Clinical Associate Professor, Emergency Medicine
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)
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
Patient safety and quality outcomes for ED patients admitted to alternative care area inpatient beds.
The American journal of emergency medicine
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
LIPPINCOTT WILLIAMS & WILKINS. 2018
View details for Web of Science ID 000453090803006
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
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
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
2006; e19: 354
View details for DOI 10.1056/NEJMvcm051914