- Emergency Critical Care
- Internal medicine/critical care medicine
- High risk pulmonary embolism
- Providing delayed comfort care in Clinical Decision Units (CDU) for ED patients with life support
- Critical Care Medicine
Clinical Associate Professor, Emergency Medicine
Honors & Awards
Certificate of Honor In Medical Education, Stanford University, CA (5/14/2019)
The Henry J. Kaiser Family Foundation Award for Excellence in Clinical Teaching, Stanford University School of Medicine (5/6/2019)
Outstanding Educator Award, Department of Emergency Medicine, Stanford University, CA (5/1/2019)
The Henry J. Kaiser Family Foundation Award for Excellence in Clinical Teaching, Stanford University School of Medicine (6/10/2015)
Save of the Month, Stanford University Emergency Medicine (9/2013)
Chief fellow, Critical Care Medicine, Stanford University, CA (7/2008-6/2009)
Co-chief resident, combined internal/emergency medicine residency program, U. of Maryland, MD (7/2006-6/2007)
Distinguished Service Award, University of Maryland Emergency Medicine, MD (7/2006-6/2007)
Distinguished Service Award, University of Maryland Emergency Medicine, MD (7/2005-6/2006)
Consulting fellow of the year, Emergency Medicine, Stanford University, CA (6/2009)
Robert J. Doherty Exemplary Teaching Resident Award, University of Maryland, MD (6/2007)
Inductee of Humanism Honor Society, University of Maryland, MD (4/2007)
Alpha Omega Alpha, University of Rochester School of Medicine, NY (10/2001)
Residency: University of Maryland School of Medicine (2007) MD
Fellowship: Stanford University Critical Care Medicine Fellowship (2009) CA
B.A., Swarthmore College, Economics (1998)
Medical Education: University of Rochester School of Medicine (2002) NY
Board Certification: American Board of Internal Medicine, Internal Medicine (2007)
Board Certification: American Board of Emergency Medicine, Emergency Medicine (2008)
Board Certification: American Board of Internal Medicine, Critical Care Medicine (2009)
Current Research and Scholarly Interests
Critical Care, optimal resource allocations for inpatient care
Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients.
The American journal of emergency medicine
2020; 41: 120–24
STUDY HYPOTHESIS: We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED.METHODS: This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality between the pre- and post-intervention periods and between non-prolonged (≤6h) boarding time and prolonged (>6h) boarding time. In-hospital mortality was stratified by illness severity (eccSOFA category) and adjusted using logistic regression.RESULTS: Severity-adjusted in-hospital mortality decreased from 12.8% pre-intervention to 12.3% post-intervention (-0.5% (95% CI, -3.1% to 2.1%), which was not statistically significant. This was despite a concurrent increase in ED and hospital crowding. The proportion of ECC patients downgraded to a lower level of care while still in the ED increased from 6.4% in the pre-intervention period to 17.0% in the post-intervention period. (+10.6%, 8.2% to 13.0%, p<0.001). Severity-adjusted mortality was 12.8% in the non-prolonged group vs. 11.3% in the prolonged group (p=0.331).CONCLUSIONS: During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
View details for DOI 10.1016/j.ajem.2020.12.067
View details for PubMedID 33421675
- Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents CUREUS 2020; 12 (1)
eccSOFA: SOFA illness severity score adapted to predict in-hospital mortality in emergency critical care patients.
The American journal of emergency medicine
2020; 41: 145–51
Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most existing illness severity scores are based on data that is not available at the time of the hospital admission decision or cannot be extracted from the electronic health record (EHR). We adapted the SOFA score to create a new illness severity score (eccSOFA) that can be calculated at the time of ICU admission order entry in the ED using EHR data. We evaluated this score in a cohort of emergency critical care (ECC) patients at a single academic center over a period of 3 years.This was a retrospective cohort study using EHR data to assess predictive accuracy of eccSOFA for estimating in-hospital mortality risk. The patient population included all adult patients who had a critical care admission order entered while in the ED of an academic medical center between 10/24/2013 and 9/30/2016. eccSOFA's discriminatory ability for in-hospital mortality was assessed using ROC curves.Of the 3912 patients whose in-hospital mortality risk was estimated, 2260 (57.8%) were in the low-risk group (scores 0-3), 1203 (30.8%) in the intermediate-risk group (scores 4-7), and 449 (11.5%) in the high-risk group (scores 8+). In-hospital mortality for the low-, intermediate, and high-risk groups was 4.2% (95%CI: 3.4-5.1), 15.5% (95% CI 13.5-17.6), and 37.9% (95% CI 33.4-42.3) respectively. The AUROC was 0.78 (95%CI: 0.75-0.80) for the integer score and 0.75 (95% CI: 0.72-0.77) for the categorical eccSOFA.As a predictor of in-hospital mortality, eccSOFA can be calculated based on variables that are commonly available at the time of critical care admission order entry in the ED and has discriminatory ability that is comparable to other commonly used illness severity scores. Future studies should assess the calibration of our absolute risk predictions.
View details for DOI 10.1016/j.ajem.2020.12.018
View details for PubMedID 33453549
Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents.
2020; 12 (1): e6785
Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.
View details for DOI 10.7759/cureus.6785
View details for PubMedID 32140345
View details for PubMedCentralID PMC7045984
- Beyond Triage and Resuscitation: Optimizing Care for the Critically Ill Emergency Department Patient. Emergency medicine clinics of North America 2019; 37 (3): xv-xvi
- Splenic Rupture Diagnosed with Bedside Ultrasound in a Patient with Shock in the Emergency Department Following Colonoscopy. The western journal of emergency medicine 2015; 16 (5): 758-759
[Current status of nurse practitioners at Stanford University Medical Center].
Nihon Geka Gakkai zasshi
2014; 115 (4): 226-230
View details for PubMedID 25154245
- The critical care literature 2010 AMERICAN JOURNAL OF EMERGENCY MEDICINE 2012; 30 (7): 1268-1273
- The critical care literature 2009 AMERICAN JOURNAL OF EMERGENCY MEDICINE 2011; 29 (5): 554-562