Provides Opinion & Testimony In:
Emergency Nursing, Emergency Room, Emergency Department, Base Station, Pre Hospital direction, Emergency Trauma, Emergency Nursing Standards,
Expert Witness No.3009
Known for being a dynamic leader with over 30 years of progressive experience and responsibility in clinical effectiveness, hospital operations, integrated system development, quality improvement, financial stewardship, and medical-legal consulting. Proven ability to design, implement, manage and grow successful programs, conduct workflow analysis, maximize charge capture, and develop and implement best practice initiatives. Experience with managing complex multi-million dollar budgets demonstrating fiscal accountability. Demonstrated ability to lead and manage multiple departments and sites, and design multi-faceted building expansion projects. Enjoy and excel in the role of mentor and management team development utilizing a collaborative practice model.
Successful in establishing solid quality outcome processes, regional patient placement programs, throughput efficiency strategies, electronic medical record development and deployment, recruitment and retention programs and improved insurance contracting. Recognized for a strong track record of consulting in the areas of nursing practice, standards of care in trauma and emergency care, throughput efficiency and construction design. Recognized for exceptional verbal and written communication skills, and being a strong collaborative team leader. Chaired and participated on numerous hospital, county, and state multidisciplinary committees.
1987 – BSN – University of Arizona
1998 – MBA – University of Phoenix
American College of Healthcare Executives – Member
Emergency Nurses Association – Member
Society of Cardiovascular Patient Care – Member
American College of Emergency Physicians – Member
October 2016 – Present: Administrator – Emergency, Urgent Care, EMS, and Provider Group Operations Presbyterian Health System, Albuquerque NM
Administrative operational oversite of four emergency departments, nine urgent sites, multi-county ambulance service, and provider group in central New Mexico.
August 1994 – Present: Private Company, Owner
Consult with healthcare facilities and software companies related to integrated system development, quality improvement, process improvement design to enhance patient experience and throughput efficiency, charge capture, expense control, and hospital construction design.
November 2015 – May 2016 – Elvis Presley Trauma Center, Memphis TN
Administrator, Emergency and Trauma Services, Patient Placement, Staffing and Discharge Lounge.
• Led Trauma Center efforts to pass three state trauma surveys
• Improved trauma team function and efficiency
• Streamlined trauma committee function to prepare for ACS
• Improved productivity metric for ED, TICU, Trauma ED and Trauma Step Down unit
• Improved patient safety related to specimen collection
• Decreased salary expense by $400,000 related to OT and non-productive metrics
• Enhanced staffing pool to improve coverage rates
• Improved patient placement process leading to decrease in patient movement
• Implemented daily management system
• Improved provider order process leading to reduction in errors
• Organized Service Line leadership structure and meeting to improve efficiency and communication
• Established structure for cross training between departments
Assist responsible attorney with case workup including medical record summary, chronology, discovery preparation, deposition preparation, literature review, deposition summary, retention and preparation of expert witnesses, and trial preparation. Practice areas include medical malpractice, products liability, class action lawsuits, personal injury, and workman’s compensation.
Serve as expert witness in the areas of emergency and trauma nursing, outpatient services, and nursing practice. Experience with both defendant and plaintiff cases.
Dec 2010-August 2015: Central Group Director –
Special Event Medical Operations and Research
Trauma Services – SMCA
University Medical Center Brackenridge
Seton Medical Center Austin
Responsibility included overall accountability for the operations of a 75,000 visit Level 1 Trauma Center, a 35,000 visit Level 4 ED, a 14 bed Observation Unit, a 17 bed Psychiatric ED, and medical operations for the Circuit of the Americas motor sports and entertainment events.
• Lead network Emergency Services Collaborative Council
• Successful Comprehensive Stroke Center re-designation
• Successful Cycle 3 Chest Pain Center re-accreditation
• Successful Level 1 Trauma Center re-designation
• Successful Magnet Hospital re-designation
• Successful TJC re-accreditation
• Meet all core measure targets for STEMI and pneumonia
• Successful contracting with providers and community businesses
• Participated on ICD-9 to ICD-10 conversion team
• Successful network wide implementation of the electronic medical record
• Successful application of LEAN methodology to process improvement projects
• Enhance process to streamline and improve revenue cycle and coding vendor expectations
• Instrumental in developing projections related to future growth
• Implemented multiple county SANE response team
• Decreased door to tPA time to <60 min
• Decreased door to device time from 89 min to 62 min
• Decreased door to EKG from 13 min to 6 min
• Decreased CLABSI rate from 2.7 to 0.6/1000 line days
• Increased patient experience scores from 18th to 85th percentile in many domains
• Network standardization of Stroke and Chest Pain order sets
• Supportive structure for both nursing and physician research
• Enhanced growth of Observation Services and decreased LOS from 26 hours to 17 hours
• Increased trauma activation net revenue by $5.8M annually
• Restructured Network ED service line to support Shared Governance
• Decreased annual expenses by $600,000
• Decreased inpatient LOS to below targets
• Decreased Trauma Priority (divert) to zero
• Improved core measures to at or above national benchmark
• Successful development and implementation of Flex Flow model
• Decreased LWBS rate from 7% to 1.8%
• Successful implementation of Clinical Supervisor model
• Successful collaborative approach to network nursing resource strategy
• Successful implementation of InQuicker program
• Created collaborative ED/ICU quality model
• Created ED/ICU education model
• Successful development and implementation of motor sports medical coverage program
• Collaborative approach leading to successful integration of newly established Emergency Medicine Residency program
• Successful development and advancement of network nursing clinical ladder
• Successful improvement of the care of psychiatric patients
• Member of multiple network, site, and community committees
May 2006–Jan 2011 Senior Director of Nursing, Emergency and Pre-hospital Services
Banner Desert Medical Center, Mesa, AZ
Cardon Children’s Medical Center, Mesa, AZ
Responsibility included overall accountability for planning, implementation and monitoring all clinical and financial aspects within Emergency Services. This service line encompasses an Adult and Pediatric ED, EMS Base Hospital, and ED coding. The Emergency Center sees approximately 97,000 patients per year with over 190 FTE.
• Successful development and implementation of system wide pediatric protocols
• Successful development and implementation of Regional Patient Placement Office for the Phoenix metro facilities
• Successful implementation of psychiatric assessment/observation program
• Successful standardization of ED job descriptions, competency training, and policies/procedures
• Successful development and implementation of Patient Transition Center
• Developed and implemented facility surge capacity plan
• Increased patient satisfaction in the Peds ED to top decile
• Successful implementation of ED computerized charting
• Successful implementation of eICU in the ED
• Successful implementation of ED Split Flow model
• Facility team lead to improve patient experience scores
• Led ED design and construction project for an 84 bed expansion
• Instrumental in redefining SE Sector no divert policy
• Successful application of Six Sigma methods for process improvement
• 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 quality core measures to above the 90th percentile
• Enhanced EMS relations in SE Valley through site visits and marketing
• Decreased EMS off load times by 50%
• Re-defined and expanded New Grad ED education program
• Decreased RN vacancy rate from 53% to 2% in one year
• Developed and implemented nursing standing orders
• Restructured service line operational structure
Member of System ED Committee; ED Shared Leadership (chair); ED Committee, Cardon Children’s Pediatric Committee; Orthopedic Committee; ED Pillars; Lab Six Sigma Team; Arizona State No Divert; Core Measures Work Group; Nursing Director Team; Patient Excellence Team; Banner Health Construction Project Team; Regional Patient Placement Committee; PACES, ED eICU Work Group, and Facility Throughput Team.
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 over 150,000 patients per year and included one Level II and two Level IV Trauma Centers with 235 FTE.
Major System Accomplishments:
• Awarded “Top Quality Outcome” award for Cardiovascular Care
• 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 in service line
• Implemented system wide sepsis and AMI protocol
• Standardized regional policy, procedures, and processes
• Instrumental in designing new Gig Harbor facility
Committee member of 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 and Trauma 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, Disaster Preparedness, and Pre-Hospital Services. Oversee functions of the clinical manager; trauma coordinators; pre-hospital coordinators; trauma nurse practitioner; data extractors/coders; business manager; and clinical educator. Lead on planning team for a $7M ED expansion project.
• Successful consolidation of two trauma centers
• Led successful citywide effort to abolish EMS divert
• Restructured Trauma Registry to enhance compliance and increase revenue
• Decreased wound infection rates by 40% in trauma service
• Successful launch of Southern Arizona Telemedicine Program
• Magnet Hospital core team member
• Decreased divert hours by 75%
• Increased annual revenue by over 36%
• Decreased nursing vacancy rate from 15% to 4.5%
• Restructured departmental organization chart, which enhanced operational performance
• Redesign triage to enhance patient flow
• Successful team enhancing surgical services throughput
• Implemented point of care testing to decrease turnaround time
• Decreased ED inpatient admission time by 40%
Member of 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 Level II Trauma Center, Emergency Department, Pediatric Emergency Department, Urgent Care, Clinical Decision Unit; and Base Hospital Services. Accountable for strategic planning; budget development and compliance; departmental operations; oversight of clinical educator and data extractor; quality improvement; staff and physician issues; interdepartmental relations; patient satisfaction; Base Hospital and Trauma operations.
• Successful implementation of EMS Cardiac Alert process to door to device time
• Decreased ED patient throughput time by 27%
• Decrease staff turnover from 52% to 19% annualized
• Decreased ED to OR time from 60 min to 30 min
• Increased staff specialty certification by 40%
• Improved hospital admission process time by 36%
• Improved EMS communication by developing hospital/EMS council
• Instrumental in establishing EMSystem community wide
Member of 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
Interim Director, Critical Care
Team Leader, Cardiovascular Service Line
El Dorado Hospital, Tucson, AZ
Responsibility included all aspects of departmental operations, including productivity; customer satisfaction; quality improvement; business development; contract review; staff competency; continuum of patient care; medical staff issues; Interim Director of Critical Care and Chief Nursing Officer.
• Expanded utilization of Ambulatory Care and Cath Lab
• Improved patient outcome through system changes and quality improvement projects
• Improved patient and physician satisfaction by 9%
• Implemented step down ICU decreasing annual expenses by $250,000
• Improved patient safety through enhancing 12 hr chart checks
• Enhanced interdepartmental relationships
• Implemented supply consignment in Cath Lab
• Decreased ED costs by 15%
• Decreased ED patient length of stay by 20%
Member of 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 Director, Emergency Services
Chairman, Cochise County Health Education Resources Consortium
Interim Director, Medical/Telemetry Unit
Sierra Vista Community Hospital, Sierra Vista AZ
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.
• Planned, implemented, and managed a countywide healthcare education consortium
• Developed and implemented countywide EMS base hospital
• Successful planning and implementation for countywide coverage of air transport services
• Increased departmental net revenue by 15%
• Decreased departmental expense by 8%
Member of 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 – Private Company, 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. Hospital responsibility for EMT and ACLS training.
Available Upon Request