Emergency Room Nursing Standards Expert Witness

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Emergency Room Nursing Standards Expert Witness

Provides Opinion & Testimony In:

Emergency Nursing, Emergency Room, Emergency Department, Base Station, Pre Hospital direction, Emergency Trauma, Emergency Nursing Standards,

Executive Summary

A recognized dynamic, versatile healthcare professional with 25+ years of progressively more responsible leadership experience and an expert in Trauma Services. A proven record of success in the management of clinical effectiveness, hospital operations, integrated system development, quality improvement and financial stewardship. Proven ability to design, implement, manage and grow successful programs, conduct insightful/actionable workflow analysis, maximize charge capture and develop and implement best practice initiatives. Experience expertly managing complex multi-million dollar budgets. Demonstrated ability to lead and manage multiple departments and sites, as well as design and implement multi-faceted building and expansion projects. While utilizing a collaborative practice model, enjoy and excel in the role of mentor and management team development.

Successes include: establishing solid quality outcome processes; regional patient placement programs; throughput efficiency strategies; patient experience initiatives; electronic medical record development and deployment; recruitment and retention programs and improved insurance contracting. Recognized for an extraordinary track record of improvements in the areas of nursing practice, standards of care in trauma, inpatient and emergency services, in throughput efficiency and construction design. Recognized for exceptional verbal and written communication skills and for being a strong, collaborative team leader. Chaired and participated on numerous hospital, county, and state multidisciplinary committees.

PROFESSIONAL EXPERIENCE

July 2018 – Current
Santa Rosa Memorial Hospital, Santa Rosa, CA
DIRECTOR OF NURSING SERVICES
Trauma Center (Regional Level II), Critical Care, Step Down, Telemetry Services, Stroke Center and Renal Services
Responsible for the overall operations, outcomes and performance of Level II Regional Trauma Center, Critical Care, Step Down, and Neuro Telemetry Services as well as Cardiac Telemetry Services, Stroke Center Program and Regional Fall Prevention.
Major accomplishments
Improved TQIP results with all indicators at or above national benchmark
Improved trauma registry IRR from 84% to 95%
Improved physician chart completion time by 8 days
Restructured Trauma Multi-disciplinary committee to enhance reporting performance
Launched geriatric fall prevention program
Decrease ICU LOS from 3.6 days to 3.2 days
Co-Leader of facility throughput initiative, reducing LOS by 0.5 days
Revised order sets to enhance improvement of TBI agitation
Revised opioid sparing order sets for trauma patients
Implemented physician rounding with improved patient experience rating
Implemented EMR interface with trauma registry
Created ICU and Trauma Program dashboard
Increased early ICU ambulation from 18% to 90%
Decreased ventilator days by 0.6 days
Implemented daily shift huddles and leader rounding
Decrease telemetry utilization by 30%
Successful implementation of TAVR/TMVR recovery process
Decreased day of discharge dialysis
Launched nurse driven early ambulation program

October 2016 – July 2018
Presbyterian Health System, Albuquerque NM
SERVICE LINE ADMINISTRATOR
Emergency, Urgent Care, EMS and Provider Group Operations
Responsible for administrative operational oversite of three emergency departments (172,000 visits/yr), eight Urgent Care sites (171,000 visits/yr), a multi-county ambulance service (130,000 transports/yr), Telemetry services, and ED provider group.
Major accomplishments
Restructured patent flow to improve efficiency measures
Consolidated central market telemetry monitoring service
Achieved Platinum Award for STEMI
Improved behavioral health consult response time by 30%
Implemented ED BH patient safety measures
Restructured operational function into 5 focus areas
Combined Telemetry/ED quality and process improvement team
Improved pharmacy delivery time by 25% in Telemetry and ED
Realigned workflow and duty list of EVS enhancing cleanliness
Aligned Stroke processes to national standards
Successful Primary Stroke Center re-designation
Implemented electronic meal selection for ED/Telemetry patients
Increased physician recruitment
Improve provider scheduling satisfaction
Enhanced patient throughput increasing provider efficiency
Streamlined ambulance supply chain decreasing expense by $30,000/yr
Improved EMS offload times by 25%
Implemented ED admission overflow area
Designed professional development plan for ED leadership

Aug 2015 – Sep 2016
Elvis Presley Trauma Center, Regional One Healthcare
Memphis TN
ADMINISTRATOR (Consultant)
Emergency & Trauma Services, Patient Placement, Staffing and Discharge Lounge
Accountable for operations and performance of the Level I Trauma Center including the Trauma Emergency Department, Adult Emergency Department, Trauma ICU, Trauma Step Down Unit, Staffing Office, and Patient Discharge Lounge.
Major accomplishments
Led Trauma Center efforts to pass three state trauma surveys
Improved trauma team function and efficiency
Restructured patient rounding format decreasing line and vent days
Streamlined trauma program to prepare for ACS
Improved productivity metric for ED, TICU, Trauma ED and Trauma Step Down Telemetry Unit
Improved patient safety related to specimen collection
Enhanced blood blank compliance and delivery time
Decreased salary expense by $400,000 related to OT and non-productive metrics
Enhanced staffing pool to improve coverage rates
Enhanced competency training in Telemetry, ICU, and ED
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

Dec 2010 – August 2015
University Medical Center Brackenridge, Seton Medical Center – Austin. Austin, TX
CENTRAL GROUP ADMINISTRATIVE DIRECTOR
Emergency Services, Observation Services, Special Event Medical Operations
and Research Trauma Services
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.
Major Accomplishments
Lead network Emergency Services Collaborative Council
Successful design and implementation of Psychiatric ED
Member of $350M hospital design team
Successful in implementation of county wide BH referral program
Successful Comprehensive Stroke Center re-designation
Successful Cycle 3 Chest Pain Center re-accreditation
Successful ACS Level 1 Trauma Center re-designation
Successful Magnet Hospital re-designation
Design and implement network wide trauma registry
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 electronic medical record (Cerner)
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 Trauma, Stroke and Chest Pain order sets
Supportive structure for both nursing and physician research
Enhanced growth of Observation Services & decreased LOS from 26 hours to 17
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
Banner Desert Medical Center, Mesa, AZ
Cardon Children’s Medical Center, Mesa, AZ
SENIOR DIRECTOR OF NURSING –
Emergency and Pre-Hospital Services
Responsibility included overall accountability for planning, implementation and monitoring all clinical and financial aspects within Emergency Services. This service line encompasses an Adult (62,000 visits) and Pediatric ED (25,000 visits), EMS Base Hospital, and ED coding with 190 FTE.
Major Accomplishments:
Successful development and implementation of system wide pediatric protocols
Designed and implemented new 20 bed Pediatric ED.
Successful development and implementation of Regional Patient Placement Office for the Phoenix metro facilities
Successful member on implementation team for 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
Franciscan Health System, Tacoma, WA
REGIONAL ADMINISTRATOR, EMERGENCY SERVICES
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
University Medical Center, Tucson, AZ
DIRECTOR, EMERGENCY AND TRAUMA SERVICES
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.
Major Accomplishments:
Successful consolidation of two Level I trauma centers
Led successful citywide effort to abolish EMS divert
Restructured Trauma Registry to enhance compliance and increase revenue
Design and implement free standing Urgent Care
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, enhancing 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
The Medical Center of Aurora, Aurora, CO
MANAGER / INTERIM DIRECTOR – EMERGENCY SERVICES
Responsible for 83,000 visits 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.
Major Accomplishments:
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
El Dorado Hospital, Tucson, AZ
DIRECTOR OF NURSING –
Emergency Services, Ambulatory Surgical & Medical Services, Cardiac Cath Lab,
Cardiac Rehab, Diabetes Care
Interim CNO and Interim Director, Critical Care
Team Leader, Cardiovascular Service Line
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.
Major Accomplishments:
Expanded utilization of Ambulatory Care and Cath Lab
Designed and implemented free standing Ambulatory Surgery Center
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
Sierra Vista Community Hospital, Sierra Vista AZ
DIRECTOR, EMERGENCY SERVICES
Chairman, Cochise County Health Education Resources Consortium
Interim Director, Medical/Telemetry Unit
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:
Planned, implemented, and managed a countywide healthcare education consortium
Developed and implemented countywide EMS base hospital
Deployed telemedicine program in 6 sites for trauma patients
Successful planning/implementation of countywide 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 – 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. Hospital responsibility for EMT and ACLS training.

EDUCATION

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

PROFESSIONAL ORGANIZATIONS

American College of Healthcare Executives
Trauma Center Association of America
Society of Cardiovascular Patient Care

PUBLICATIONS/PRESENTATIONS

Available on request

Groups