Bio

Clinical Focus


  • Internal Medicine
  • Hospital Medicine

Academic Appointments


  • Clinical Assistant Professor, Medicine

Administrative Appointments


  • Chief Medical Officer, Stanford ValleyCare (2017 - Present)
  • Medical Director Hospitalist Team, Stanford ValleyCare (2015 - Present)
  • Ambulatory Network Optimization Task Force/System Referrals Work group, Stanford Health Care (2018 - Present)
  • Academic University Hospitalist, Stanford Hospital and Clinics (2012 - Present)
  • Faculty Mentor, Core Faculty Mentoring Program (2013 - Present)
  • Director, Medicine Consult / Procedure Team Rotation (2013 - Present)
  • High Value Care Representative, Stanford HealthCare (2017 - Present)
  • Member, SHC Bylaws Committee (2015 - 2016)
  • Member, Department of Medicine Quality Council (2013 - 2015)
  • Medicine SIP, Stanford Hospital (2014 - 2015)

Honors & Awards


  • Melinda Mitchell Quality Award, Stanford Health Care (2018)
  • David A. Rytand Clinical Teaching Award, Stanford University - Department of Medicine (2016)
  • Lawrence Mathers Award:Exceptional Commitment to Teaching / Active Involvement in Medical Student Ed, Stanford School of Medicine (2016)
  • VPTL Grant, Stanford University (2016)
  • Arthur L. Bloomfield Award for Excellence in Clinical Teaching, Stanford University Medical School (2014)
  • David A. Rytand Clinical Teaching Award, Stanford University - Department of Medicine (2014)
  • Medical Honor Society, Alpha Omega Alpha (2009)
  • Business Honor Society, Beta Gamma Sigma (2009)

Boards, Advisory Committees, Professional Organizations


  • Participant, Stanford Leadership Development Program (2014 - 2015)
  • Member, Society of Hospital Medicine (2013 - 2014)

Professional Education


  • Medical Education:Case Western Reserve School of Medicine (2009) OH
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2012)
  • MBA, Case Western Reserve University - Weatherhead School of Management (2009)
  • Residency:Stanford University (2012) CA
  • BA, University of Notre Dame, Economics - Pre-Medical Studies

Research & Scholarship

Current Research and Scholarly Interests


High Value Care: Leading quality improvement projects / research initiatives

Projects


  • Cost Savings Reinvestment Program, Stanford Health Care (2017 - 2019)

    The Appropriate Use of Accommodations Project – Level of Care
    Instituted two Best Practice Alerts and recruited faculty champions throughout hospital to drive value at Stanford HealthCare

    Location

    Stanford California

  • Clinical Excellence Research Center - AIM project, Clinical Excellence Research Center (2014)

    Assisted in developing data collection tools to explore relative efficiency and quality between health groups. Developed interview guides and/or questionnaires using clinical scenarios to explore care delivery models and practice patterns for Interventional Cardiology, General Cardiology and Nephrology.
    Site Visit Lead: University of Alabama Site Visit

    Location

    94304

  • Stanford Healthcare Consulting Group - Observation Status: Denial of Admissions and Reimbursement (2013 - 2014)

    Hospital Mentor for SHCG: Understand implications of miscategorization “observation status” vs. “inpatient.” The project quantified the rate of patient miscategorization, modeled the substantial financial impact of misclassification (for patients and SHC), and developed recommendations to minimize future errors.

    Location

    United States

  • Stanford Healthcare Consulting Group - Supporting Clinically Appropriate and Cost-effective Lab Test Utilization (2013 - 2014)

    Hospital Mentor for SHCG: Lab test overutilization is a widespread challenge at virtually all medical centers, leading to substantial costs and in some cases, placing patients at risk from unnecessary follow-up tests and procedures. SHCG examined the most commonly-ordered lab tests by cost and volume to evaluate which tests are inappropriately ordered. The team provided reasons for lab test overutilization and prepared evidence-based recommendations to address this problem.

    Location

    United States

  • Stanford Healthcare Consulting Group - Barriers to Discharge for Clinical High Risk Patients (2014)

    Identified barriers to discharge for clinical high risk patients by recording reasons for delayed discharges through:
    a.Data collection at clinical high risk patient meetings
    b.Interviews of team care members (RNs, case managers, MDs, etc.)
    Examined the primary barriers to discharge and determine how/when they arise.
    a.Stratified by medical unit and patient’s primary medical condition to determine whether barriers may be unique to these factors.
    Assessed the financial burden as a result of delayed discharges.
    Formed recommendations to address these primary barriers to discharge that may be implemented in the immediate future, as well as, in the short term and long term.
    Work Presented at ACP Northern California in November 2014

    Location

    United States

  • Stanford Healthcare Consulting Group - ED Admissions Project (2013)

    Hospital Mentor for SHCG: The ED Admissions project team has studied emergency room admissions processes and the determinants of patients being admitted to telemetry and non-telemetry beds as well as patients being admitted under inpatient or observation status. By analyzing ED admissions data, conducting a wide range of interviews with key staff and stakeholders, and closely observing ED operations, the team has improved understanding of how admitted patients are currently being placed and developed recommendations for improvement.

    Location

    94304

  • Practice of Medicine - Preceptors (2012 - Present)

    Practicum preceptors have the opportunity to work with 2 different groups of students teaching history taking skills / physical examination skills.

    Location

    94304

  • Stanford Healthcare Consulting Group - Cost Per Case (2014)

    The University HealthSystem Consortium (UHC) is a data driven collaboration among nonprofit academic medical centers across the nation. The purpose of this alliance is to drive and support better patient care by sharing data to identify areas of improvement in patient outcomes, quality of care and costs. The SHCG group project aims to understand Stanford's cost per case.

    Location

    Stanford Ca

  • SHIELD: Patient Partners Program (2014)

    A Co-Director of the Patient Partners Program, an innovative longitudinal patient-student service curriculum within SHIELD (Stanford Healthcare Innovations and Experiential Learning Directive)

    Location

    Stanford Ca

  • Stanford Healthcare Consulting Group - Follow-up Scheduling (2015)

    Location

    Stanford Ca

  • Stanford ValleyCare: Inpatient Rotation - Developer: Internal Medicine Resident, Stanford ValleyCare

    Location

    Pleasanton, Ca

  • Stanford ValleyCare: Inpatient Rotation - Developer - PA Student Rotation

    Location

    Pleasanton, Ca

  • Stanford Healthcare Consulting Group - Clinical Decision Unit (2016)

    Location

    Stanford Ca

  • Smart wearable devices and patient mobility and sleep during acute hospitalization, ACP Poster (2016)

    Location

    stanford california

  • An Intervention to Reduce Telemetry Use at an Academic Center and Its Impact on Rapid Response Team and Code Events, ACP Poster (2016)

    Location

    Stanford California

  • Interprofessional Education for 21st Century Care

    Trainees are put into clinical multidisciplinary teams with little knowledge about their non-MD colleagues. Trainees often are not aware of the specialized expertise these healthcare professional team members possess (e.g. social work, case management, nursing, respiratory therapy, and occupational therapy) and are compelled to try to understand the often vague and fraught environment of interdisciplinary hierarchies and team dynamics. This lack of knowledge and training results in confusion and missteps that can lead to patient care errors, poor communication, hostile working conditions, and decreased job satisfaction. Our project will survey interns and allied health professionals to identify knowledge gaps and barriers to inter-professional practice. The information will be used to create teaching videos addressing these gaps, while also stimulating discussion about hierarchies in healthcare, as well as goals of, and potential barriers to, collaboration in practice. Videos will be targeted towards medical students and advanced practice providers, preparing them for inter-professional collaboration when entering practice, clerkships and residencies.

    Location

    Stanford CA

    Collaborators

  • Stanford Healthcare Consulting Group - Long Length of Stay Evaluation (2017)

    Optimizing length of stay (LOS) was identified as one of the overall Stanford Health Care quality initiatives across all departments. This project involved exploring who the LLOS patients were, the barriers to discharge, the workflow, and recommendations for addressing this important hospital issue

    Location

    Stanford California

  • Collaborate as a Member of an Interprofessional Team—How can we ensure students are ready?, ACP Abstract

    ACP Abstract

    Location

    Stanford University

  • Stanford ValleyCare - Hepatology Transfer Project, Stanford (2016 - 2017)

    Location

    Stanford University

  • Stanford ValleyCare - Vascular Surgery Transfer Project, Stanford University (2016 - 2017)

    Location

    Stanford University

    Collaborators

    • Rudy Arthofer , Stanford HealthCare, SHC
  • Stanford Cardiac Monitoring BPA (Best Practice Alert), SHC (2016 - 2017)

    Location

    Stanford University

  • Stanford ValleyCare Epic Deployment (2017 - 2018)

    Location

    Pleasanton

  • Stanford ValleyCare: Telestroke/Primary Stroke Center (2018)

    Location

    Pleasanton

  • A Simple Click: Cost Savings of Best Practice Alerts to Decrease Inappropriate Level of Care Assignments, QIPSS (5/14/2018)

    Jingkun Yang MD [1], Jessica Ferguson MD [1], Surbhi Singhal MD [1], Christopher Sharp MD [1], Benjamin Leung [1], Dale Beatty DNP RN [1], David Svec MD MBA [1], Lisa Shieh MD PhD [1] Abstract for the Resident/Fellow Quality Improvement/Patient Safety Symposium (QIPSS)

    Location

    stanford

  • Rationale and design of the EARLIER* trial: a randomized evaluation of modest monetary incentives to facilitate prompt patient discharge planning, SHC (May 2018)

    QI Symposium - Ginger Yang, Lisa Shieh, Bo Wang

    Location

    Stanford

  • Inpatient Length of Stay Increases Due to Consult Delays, Stanford HealthCare (May 2018)

    Arifeen S Rahman, AB1; Pamela Meza, BS1; Siyu Shi, BS1; Justin Jia, BS1; David Svec, MD, MBA2; Lisa Shieh, MD, PhD2
    Stanford University School of Medicine1 and Department of Medicine2, Stanford, CA

    Location

    Stanford

Publications

All Publications


  • Hospitalist intervention for appropriate use of telemetry reduces length of stay and cost JOURNAL OF HOSPITAL MEDICINE Svec, D., Ahuja, N., Evans, K. H., Hom, J., Garg, T., Loftus, P., Shieh, L. 2015; 10 (9): 627-632

    View details for DOI 10.1002/jhm.2411

    View details for Web of Science ID 000360836000012

  • A long wait: barriers to discharge for long length of stay patients. Postgraduate medical journal Zhao, E. J., Yeluru, A., Manjunath, L., Zhong, L. R., Hsu, H., Lee, C. K., Wong, A. C., Abramian, M., Manella, H., Svec, D., Shieh, L. 2018

    Abstract

    INTRODUCTION: Reducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.METHODS: We conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.RESULTS: Discharge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.CONCLUSION: Together with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

    View details for DOI 10.1136/postgradmedj-2018-135815

    View details for PubMedID 30301835

  • Reducing Telemetry Use Is Safe: A Retrospective Analysis of Rapid Response Team and Code Events After a Successful Intervention to Reduce Telemetry Use. American journal of medical quality : the official journal of the American College of Medical Quality Xie, L., Garg, T., Svec, D., Hom, J., Kaimal, R., Ahuja, N., Barnes, J., Shieh, L. 2018: 1062860618805189

    Abstract

    Interventions guiding appropriate telemetry utilization have successfully reduced use at many hospitals, but few studies have examined their possible adverse outcomes. The authors conducted a successful intervention to reduce telemetry use in 2013 on a hospitalist service using educational modules, routine review, and financial incentives. The association of reduced telemetry use with the incidence of rapid response team (RRT) and code activations was assessed in a retrospective cohort study of 210 patients who experienced a total of 233 RRT and code events on the inpatient internal medicine services from January 2012 through March 2015 at a tertiary care center. The incidence of adverse events for the hospitalist service was not significantly different during the intervention and postintervention period as compared to the preintervention period. Reducing inappropriate telemetry use was not associated with an increase in the incidence rates of RRT and code events.

    View details for DOI 10.1177/1062860618805189

    View details for PubMedID 30293436

  • A long wait: barriers to discharge for long length of stay patients PMJ; BMJ Zhao, E. 2018
  • Reducing Telemetry Use is Safe: A Retrospective Analysis of Rapid Response Team and Code Events After a Successful Intervention to Reduce Telemetry Use American Journal of Medical Quality Lijia, X., Svec, D., Hom, J., Ahuja, N., Garg, T., Kaimal, R., Barnes, J., Shieh, L. 2018
  • Barriers to timely discharge from the general medicine service at an academic teaching hospital. Postgraduate medical journal Ragavan, M. V., Svec, D., Shieh, L. 2017

    Abstract

    Reducing delays for patients who are safe to be discharged is important for minimising complications, managing costs and improving quality. Barriers to discharge include placement, multispecialty coordination of care and ineffective communication. There are a few recent studies that describe barriers from the perspective of all members of the multidisciplinary team.To identify the barriers to discharge for patients from our medicine service who had a discharge delay of over 24 hours.We developed and implemented a biweekly survey that was reviewed with attending physicians on each of the five medicine services to identify patients with an unnecessary delay. Separately, we conducted interviews with staff members involved in the discharge process to identify common barriers they observed on the wards.Over the study period from 28 October to 22 November 2013, out of 259 total discharges, 87 patients had a delay of over 24 hours (33.6%) and experienced a total of 181 barriers. The top barriers from the survey included patient readiness, prolonged wait times for procedures or results, consult recommendations and facility placement. A total of 20 interviews were conducted, from which the top barriers included communication both between staff members and with the patient, timely notification of discharge and lack of discharge standardisation.There are a number of frequent barriers to discharge encountered in our hospital that may be avoidable with planning, effective communication methods, more timely preparation and tools to standardise the discharge process.

    View details for DOI 10.1136/postgradmedj-2016-134529

    View details for PubMedID 28450581

  • A High Value Care Curriculum for Interns: A Description of Curricular Design, Implementation and Housestaff Feedback. Postgraduate Medical Journal Hom, J., Kumar, A., Evans, K., Svec, D., Richman, I., Fang, D., Smeralgio, A., Holubar, M., Johnson, T., Shah, N., Renault, C., Witteles, R., Ahuja, N., Harman, S., Shieh, L. 2017
  • Physicians and blocking: can we tear down this wall? Postgraduate medical journal Wang, B., Svec, D. 2017

    View details for DOI 10.1136/postgradmedj-2017-135115

    View details for PubMedID 28814572

  • Interprofessional Collaboration: A Qualitative Studyof Non-Physician Perspectives on Resident Competency Interprofessional Collaboration: A Qualitative Studyof Non-Physician Perspectives on Resident Competency Garth, M., Millet, A., Shearer, E., Stafford, S., Merrell, S. B., Bruce, J., Schillinger, E., Aaronson, A., Svec, D. 2017
  • Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD) EDUCATION FOR PRIMARY CARE Lin, S., Osborn, K., Sattler, A., Nelligan, I., Svec, D., Aaronson, A., Schillinger, E. 2017; 28 (3): 180–84
  • The effect of dehydroepiandrosterone on Zucker rats selected for fat food preference Physiology & Behavior Pham J, Porter J, Svec D, Eiswirth C, Svec F. 2000; 70 (5): 431-41