Emergency Room Nursing Standards Expert Witness

Expert Witness No.3009

Education

1987 - BSN – University of Arizona
1998 - MBA – University of Phoenix

Professional Organizations

American College of Healthcare Executives – Member
American Organization of Nurse Executives – Member
Arizona Organization of Nurse Executives – Member
Emergency Nurses Association – Member

Professional Experience

May 2006–Present             Senior Director of Nursing, Emergency Center
Banner Desert Medical Center, Mesa, AZ

Responsibility includes overall accountability for the planning, implementing and monitoring of all processes, clinical and financial, within Emergency Services, including the Adult ED, Pediatric ED, and EMS.  The Emergency Center sees approximately 92,000 patients per year with over 232 FTE, and an operational budget of over $23M with revenues in excess of $99M.

Major Accomplishments:
Instrumental in redefining SE Sector no divert policy
Developed and implemented Split Flow ED model
Decreased Door to Doc average time from 168 minutes to 43 minutes
Decreased left without treatment rate from 9% to 1.5%
Increased door to doc within 30 minutes from 8% to 75% in 14 months
Improved core measures to at or above 90th percentile
Enhanced EMS relations in SE Valley through site visit and marketing
Decreased EMS off load times by 50%
Re-established SE ED Nursing Director meetings
Decreased RN vacancy rate from 53% to 2% in one year
Developed and implemented nursing standing orders
Successful implementation of eICU in the ED

Committee member on ED Shared Leadership (chair); ED Committee, Children’s Hospital Pediatric Committee; Orthopedic Committee; ED Patient and Staff Satisfaction; Lab Six Sigma Team; Pediatric Executive Committee; Arizona State No Divert Committee; Core Measures Work Group; Nursing Administration Team; Nursing Operations Team; System ED Committee; Banner Health Construction Project Team; Regional Patient Placement Committee; PACES, ED eICU Work Group, and Facility Throughput Team.

1995–Present          A Private Medical Consulting Firm
Owner

Consult with plaintiff and defense attorneys on matters related to medical malpractice, personal injury and workman’s compensation cases.  Perform medical record review and summary, expert witness selection, deposition preparation for witnesses and experts, trial preparation, deposition summary, and assist with preparation of correspondence, answers to interrogatories, and disclosure statements.

2004-2006       Regional Director, Emergency Services
Franciscan Health System, Tacoma, WA

Responsibility included providing leadership and direction for system wide, multi-facility emergency services, disaster preparedness, and EMS.  This system provided care to nearly 150,000 patients per year and included one Level II and two Level IV Trauma Centers with 235 FTE.  Accountable for all operations, planning and projections, quality patient care and medical staff issues of this $150M service line. 

Major System Accomplishments:
Enhanced system wide no divert policy
Redesigned triage to improve patient throughput
Finalized plans and provided oversight of $1.6M expansion project
Created ED System cultural expectations guidelines – “Patient First Initiative”
Finalized ED System flow for computerization implementation
Restructured staff education/orientation program
Enhanced quality improvement monitoring
Implemented new design for documentation compliance
Successfully passed trauma center certification for system
Successfully passed JCAHO survey with zero RFI’s
Implemented system wide sepsis and AMI protocol
Regionalized policy and procedures

Committee member on Professional Nursing Council; Pierce County EMS Council; ED Leadership Team (chair); Professional Regional Operations Council; Access to Care (Chair); Pierce County Hospitals Divert Task Force; Regulatory Compliance Group; Regional Coordinating Council; Master Site Planning Group; St. Anthony’s Hospital Planning Group (new construction); Trauma Care Council; and City of Lakewood Disaster Planning Committee.

2001-2004      Director – Emergency, Trauma, Disaster and Pre-hospital Services
University Medical Center, Tucson, AZ
Responsibility included providing leadership and direction for this 68,000 visit per year, 36 bed, 152 FTE, Level I Trauma Center, Emergency Department, Urgent Care, and Pre-Hospital Services.  Accountable for all operations; strategic planning; projections and variances of a $60M budget; and medical staff issues related to areas of responsibility.  Oversee functions of the clinical manager; trauma coordinators; pre-hospital coordinators; trauma nurse practitioner; data extractors/coders; business manager; and clinical educator.  Directed the planning process for a $7 million ED expansion project.

Major Accomplishments:
Decreased divert hours by 75%
Increased annual revenue by over 36%
Decreased vacancy rate from 15% to 4.5%
Restructured departmental organization chart, which enhanced operational performance and issue resolution
Redesign triage to enhance patient flow
Implemented point of care testing to decrease turnaround time
Successful program development for becoming the sole trauma center
Decreased ED inpatient admission time by 40%

Committee member on Emergency Department Operations (Chair); Combined Leadership; Nursing Leadership; Magnet Hospital Accreditation; Access to Care (Chair); Patient Care Executive Committee; Patient Care Operations; Provision of Care (Chair); Trauma Operations; Pre-hospital Care; Admission/Discharge Process Task Force (Chair); Pediatric Care; Cost Containment; Regulatory Compliance; Disaster Preparedness; Clinical Practice; Pima County Sexual Assault Collaboration Committee; Alternative Works/Staffing Committee; Staff Development; and multiple quality improvement teams.

2000-2001      Manager/Interim Director – Emergency Services

The Medical Center of Aurora, Aurora, CO

Responsible for 83,000 visit per year, 54 bed, 95 FTE, Level II Trauma Center, Emergency Department, Pediatric Emergency Department, Urgent Care, and Clinical Decision Unit.  Accountable for strategic planning; budgetary development and compliance; departmental operations; oversight of clinical educator, data extractor; quality improvement; hiring; staff and physician issues; interdepartmental relations; patient satisfaction; EMS and Trauma operations.

Major Accomplishments:
Decreasing turnaround time by 27 percent
Decrease staff turnover from 52 percent to 19 percent annualized
Decreased ED to OR time from 60 minutes to 30 minutes
Increase percent of staff certification by 40%
Improve hospital admission process time by 36 percent
Improve EMS communication by developing hospital/EMS council
Instrumental in establishing EMSystem community wide
Instrumental in establishing Cardiac Alert to improve ED to Cath Lab time

Committee member on all section meetings of the Medical Staff; Surgical Services; ED Advisory; Safety and Security; Nursing Cabinet; Recruitment and Retention; Disaster Preparedness; Trauma/EMS; Divert; Registration; and Bed Placement.

1997-2000      Director – Emergency Services, Ambulatory Services, Cardiac Cath Lab,
Cardiac Rehab, Diabetes Care
Team Leader, Cardiovascular Service Line
El Dorado Hospital, Tucson, AZ

Responsibility included departmental financial viability; customer satisfaction; continuous quality improvement through interdisciplinary teams; business development; contract review; staff competency for all age groups; continuum of patient care; medical staff issues; and backup and interim director of Critical Care and CNO.

Major Accomplishments:
Decreased departmental costs by 15%
Decreased patient wait times and length of stay 20%
Improved patient and physician satisfaction by 9%
Enhanced interdepartmental relationships
Expanded Ambulatory Care and Cath Lab
Improved patient outcome through system changes and quality improvement projects
Oversaw initial planning of ED expansion project

Committee member on the Performance Improvement Team; Surgical Services; County Disaster Preparedness; Institutional Review Board; Cardiac Service Line Team; Collaborative Counsel; and Best Demonstrated Practice Task Force.

1994-1997      Manager – Emergency Services
Sierra Vista Community Hospital, Sierra Vista AZ
Chairman, Cochise County Health Education Resources Consortium

Responsible for financial and quality improvement; personnel; operations; physical plant; policy and procedure; public relations; contract development; medical staff issues; interdepartmental issues; computerization; oversight of county wide medical education; development of rural trauma network in conjunction with Level I trauma center; helicopter transport utilization; and strategic planning.

Major Accomplishments:
Increased departmental net revenue by 15 percent
Decreased costs by 8 percent
Planned, implemented, and managed a countywide healthcare education consortium
Developed and implemented countywide EMS base hospital
Justified and contracted countywide air transport services

Committee member on Critical Care; Safety and Risk Management; Computer Steering; CPS Review Board; Pre-Hospital Care; Surgical Services; multiple CQI teams; Cochise County EMS; Southeast Arizona EMS; and State Trauma Advisory Board Policy and Procedure Committee.

1990-1994       Nurse Consultant – Snell and Wilmer Law Firm, Tucson, AZ

Assist attorneys in the review of lawsuits in the areas of medical malpractice, product liability, personal injury, and workman’s compensation.  Interview and assist with deposition of medical and engineering experts and witness.  Prepare correspondence to experts, risk manager, and clients.  Assist with trial and witness preparation.

1987-1994       Assistant Nurse Manager – University Medical Center, Tucson, AZ

Provided Emergency Nursing care to patients in a Level I Trauma Center as staff nurse (2 yrs.), Assistant Nurse Manager (1 yr.), and per diem (4 yrs.).  Air Care fixed-winged aircraft flight nurse.  Interact with multiple healthcare disciplines, and participated in quality improvement programs for the entire hospital.  Responsible for personnel, policy and procedure, and quality patient care.

1987-1990       Owner/Operator – Desert Living Adult Care Home, Tucson, AZ

Responsible for financial, operational, public relations, and state certification aspects of residential assisted living care home.

1985-1987        Tucson Medical Center, Tucson, AZ

EKG and Holter Monitor Technician

1982-1985        Nursefinders, Tucson, AZ

Provide nursing assistant care to homebound and nursing home patients.

1978-1982        U.S.A.F. Academy Hospital, Colorado Springs, CO

Provide patient care in the ICU and Emergency Department for all age groups.  Responsible for EMT and ACLS training.