Mr. Frank Cardoza came to the unit as well as an experienced and successful CRNA who has many years of experience. Mr. Cardoza started his tour at the VA in Interventional Radiology and Gastroenterology. From there he was asked if he would offer his knowledge and assistance with helping other VA departments in which his expertise was greatly needed to service our Vets. Mr. Cardoza gladly accepted the proposal to assist in PACU when staffing was extremely short. He then was asked if he would offer his assistance in the infusion and PICC line service since he was already experienced in placing central lines. He greatly accepted this request once again to help the Veterans. Then Oncology had a major shortage and needed a provider to fill in who is a quick learner and had experience with central lines. Mr. Cardoza then again accepted this offer to service another VA department – all under the same manager. Mr. Cardoza gladly rearranged his schedule to accommodate the Department of Oncology and Hematology to assist and service their immediate needs. Once staffing was adequate, he then returned to his passion for helping the Vets in the Department of Gastroenterology and Pulmonology which he now resides and has taken on a greater leadership role as a Clinical Nurse Leader.
In this role, Mr. Cardoza has flourished into a great leader managing day-to-day clinical workflow. As a leader in preparing for Central Office presentations in which he reports the progress of these changes. Moreover, Mr. Cardoza also independently plans the care for daily procedural and clinic patients and directs his team of GI Physicians, Registered Nurses, Medical instrument technicians, and LVNs to accomplish the plan for daily activities.
As Clinical Nurse Leader, Mr. Cardoza plays a pivotal role in the daily operations of the Sacramento Gastroenterology Unit, which is a very busy service for the Department of Medicine. He is very passionate, has a very strong work ethic, is committed to his patients, and makes every effort to ensure things are arranged and executed properly. In addition to the over 2000 patient consults and follow-ups seen in the regular clinics, the GI Unit performs over 3000 outpatient and inpatient endoscopy procedures annually, ranging from simple diagnostic endoscopy to advance therapeutic procedures, including endoscopic ultrasound and Endoscopic Retrograde Cholangiopancreatography (ERCP). He plays an important role in coordinating the day-to-day activities between the front desk personnel, nursing service, physicians, and technicians. He assigns responsibilities to appropriate staff to assist physicians and liaises with the technicians to ensure a smooth-running service. In the case of a staff shortage, he is ready to jump in and personally take over, assisting with sedation, as well as recovery of patients, to minimize the extraordinary burden on and provide relief to the staff.
Workload statistics indicate the number of consults we're receiving and the number of procedures we're performing has increased significantly over the past year. In an effort to address the growing demands on our service, Mr. Cardoza liaises with the front desk BDMS staff and our Colorectal Cancer (CRC) Nurse Coordinator and Administrative Assistant to ensure patients continue to receive their appointments in a timely manner and in special cases, he makes arrangements for admission, overnight observation or a hotel for patients who need special accommodations. Frank has volunteered to work at the Saturday Colonoscopy Clinic to assist with patients who cannot undergo a colonoscopy during the week. He personally worked with the Chief of Anesthesiology to arrange through regular communication, with the Anesthesiology Department, confirming availability of General Anesthesia (GA) support, as well as personally contacting patients and their families to make the necessary arrangements. By working closely with the Anesthesiology Department, Mr. Cardoza has been able to secure more frequent General Anesthesia (GA) cases for our patients and the number of those cases has increased significantly in large part due to his efforts.
Another important task that Mr. Cardoza oversees is the inventory of equipment and supplies in the GI unit, which is facilitated by his working with the Nurse Managers and Technicians to ensure proper equipment and adequate supplies are on hand for procedures. Working with the Nurse Manager, Mr. Cardoza made arrangements ensuring proper functioning and technologically advanced equipment is available and being utilized, ensuring an efficient and smoothly operating GI service; an example being probes for the Esophageal Manometry service and researching the possible acquisition of Rectal Manometry equipment for FY2020. He also liaises and communicated with vendors to procure expensive accessories in a timely manner, such as expandable metal stents for palliation of terminally ill patients. These are usually very expensive accessories that we don't routinely stock in order to avoid their expiring while in storage. He has done an excellent job in coordinating and making these devices available on the day of procedure(s), minimizing the waste of financial resources. Mr. Cardoza is also working with our Pulmonary Physicians to submit a request to purchase Endoscopic bronchial Ultrasound (EBUS) as part of the Bronchoscopy Service this year.
VA Central Office (VACO) has mandated tracking physician performance through monitoring the outcomes of colonoscopies as part of colon cancer screening. As such, Mr. Cardoza has worked with one of our former staff and set up an adenoma tracking software program, which is being used to record adenoma detection rates for our providers. He, and one of the staff, now maintain the program and ensure that providers are compliant with entering the pathology of polyps removed during each colonoscopy. It's now easy to pull data for each individual provider and report to VA Central Office (VACO) as part of monitoring for MDs performance. This performance tracking system is not only being utilized in Sacramento but the Martinez and Redding GI services as well. As part of the Veterans Choice Program, Mr. Cardoza and the CRC Coordinator have developed a tracking system using an Excel spreadsheet to monitor the flow of outstanding consults >30 days, in order to improve scheduling of patients with the goal of seeing patients within 30 days of the Consult Indicated Date (CID). The team also reviews aging consults with BDMS, educating patients as to their available options per the Veterans Choice program. Mr. Cardoza also reviews and assist patients who need follow up appointments, who develop complications after procedures, and patients requesting early appointments. With the concerted effort of the team, we have been able to triage consults and improve access by increasing clinic availability and flexibility, ultimately eliminating the Electronic Waitlist (EWL). In the absence of the Nurse and Assistant Nurse Managers, one of the other GI Service's Nursing Supervisor reached out to Mr. Cardoza and he immediately made plans to visit the site to assist in resolving the issues at hand and did so without any hesitation or reservation.
Mr. Cardoza continues to take on a leadership responsibility aside from being a Lead Clinical Nurse. He started chairing the Unit Based Council (UBC), assists in presenting new data that is evidence-based to help the Central Office in determining our progress and does the education for different VA departments in the VISN 21 area. For instance, he was asked to present lectures on Procedural Sedation and Airway Management during GI skills day for the last five years and because of his expertise, he was able to make it easy for the GI Service from across the VANCHCS and other services such as IR, ED, and Cath lab to get certified, recertified and yearly competencies. Mr. Cardoza continues to grow as a leader. Over the past year, Mr. Cardoza is primarily responsible for helping improve the efficiency as a workforce leader increasing workload productivity up to 43% in the first two quarters alone for this fiscal year, incorporating feedback from GI leadership and Central Office (CO) recommendation in which he participates as a nursing representative with the GI leadership team. He provides monthly feedback to the VACO virtual visit. In his role as a leader, he was concerned about the performance and efficiency of the workflow with our existing process. This resulted in the complete revamping of the workflow in the Department of Gastroenterology per VACO recommendation. Mr. Cardoza spearheaded the transition by leading the nursing staff and ancillary staff through the changes by organizing and unifying the team to work efficiently and effectively. After three months of trial, the transition was a success and was recognized locally (by the VA NCHCS PENTAD) and nationally (by the VACO). Improving workload efficiency (43%) and reduction of backlog for GI Clinic and procedures. Because of this, GI service (VANCHCS) is being recognized nationally for its improved efficiency and productivity doing colonoscopies. This has now placed VANCHCS GI on the map nationally as a success story on how changes in workflow improve access within the VA. Currently, GI Mather has been invited to "The Office of Veterans" Access to Care FY19 Access Conference. This allotted Mr. Cardoza the opportunity to present this national critical information in which he educated, trained, and completed the competency of not only the GI staff but also other staff from various departments throughout the VA locally and out of town which includes coverage from Sacramento to Martinez to Chico to Redding to Oakland all within the VA Northern California Health Care System (VANCHCS).
Mr. Cardoza organizes the Annual Skills Day activities for the GI Service. In doing so, he liaises with various companies and vendors to provide manpower support and equipment for the one-day training event. The annual training is essential for all GI staff to demonstrate and meet their competency in operating all equipment and accessories, in order to maintain their privileges in assisting with endoscopy procedures and to ensure they understand how different and new accessories are being utilized. He also monitors compliance and coordinates training of GI MDs, reminding them of their respective training needs based on TMS reporting, especially Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS), due to sedation credentialing. He also works with individual vendors to provide regular in-service for all GI staff to familiarize themselves with new equipment and/or procedures as required. As Clinical Nurse Leader, Mr. Cardoza ensures staff are trained and cross-trained to provide the highest level of quality of care to our patients while efficiently addressing our patient's needs, including scheduling appointments, proper pre-/post-procedure care, and 24-hour follow-ups. With the help of all team members, we've achieved an extremely high patient satisfaction score (an average of 9.8 out of 10) from patients having endoscopic procedures here in the Sacramento GI service. Mr. Cardoza's nursing practice follows the Standards and Guidelines as set forth by the National Society for Gastrointestinal Nurses and Assistants (SGNA). He has taken an active interest in teaching and demonstrated very strong leadership skills, by organizing and coordinating teaching activities hosted by the GI service for all GI staff and community GI assistants, particularly the Annual Colorectal Cancer Screening Symposium. As Clinical Nurse Leader, Mr. Cardoza has significantly contributed to the BI- Annual ABCs of ERCP, a training conference for community GI nurses involving simulation of ERCP procedures.
Mr. Cardoza has a positive working relationship with the staff and frequently jumps in to help other co-workers in need. Not just from within the GI department, but also helping other departments as well. For example, there was a critical staffing shortage in our Oncology Department and patients are in peril of not getting their chemo treatments which are imperative for their survival. Upon knowing the need Mr. Cardoza volunteered himself to help cover the staffing needs in oncology until the staffing situation was resolved. His action, support, and desire to assist Vets prevented patients from getting canceled and continue receiving their lifesaving treatments. He did this for several months on and off. Not only did he support the staffing shortage need for Oncology, but he selflessly supported the staffing needs for the following services such as IR, PACU, PICC, and Supervisory Nursing service and volunteered to assist with BHICU staffing without hesitation when asked. Mr. Cardoza is a wealth of knowledge and experience and his collaborative nature is an asset to the Department of Veterans Affairs. As part of safety monitoring for the use of protective gear for Fluoroscopy procedures, Mr. Cardoza has worked with the GI nurses and technicians to conduct annual checks of lead aprons and shielding to ensure they are in proper working condition while enforcing precautions so that all staff takes the necessary measures to protect themselves and the patients when assisting with such procedures.
Scope reprocessing is another major safety concern, because of recent reports of Carbapenem-Resistant Enterobacteriaceae (CRE) Bacteria being isolated from improperly reprocessed Endoscopes, possibly contributing to patients' deaths. Mr. Cardoza has worked with the Sterile Processing Service (SPS) and our GI technicians to ensure that all technicians receive in-service(s) from the vendor for proper reprocessing techniques, to ensure the safety of our patients. We are extremely fortunate not to have observed any incidents from improper scope reprocessing. With the help of the Nurse and Assistant Nurse Managers, Mr. Cardoza supported the growth of the Unit Based Council within the GI service, by encouraging staff to take up individual projects such as tracking patient satisfaction, monitoring bowel prep results, and tracking quality indicators for colonoscopies, including adenoma detection rates and other performance enhancement projects to improve patient care. In the absence of the Nurse and Assistant Nurse Managers, Mr. Cardoza coordinated a meeting with BDMS, our Colorectal Cancer Coordinator, and Medical Support Assistants to develop a response plan for the Veteran Choice Program. The team assisted staff and providers in understanding while standardizing, as well as streamlining the scheduling process of appointments, in order to accommodate our patients' needs and referring patients for community care, if there is a substantial wait time. Despite offering our patients community care, the majority of our patients preferred to wait and receive GI care here at the VA. This is a huge testament to the quality of service the GI unit provides our veterans. Mr. Cardoza continues to meet regularly with our Colorectal Cancer Coordinator to ensure that patients attending the Pre-Colonoscopy Preparation Education Class receive clear instructions for bowel preparation to ensure a smooth and efficient colonoscopy procedure. Mr. Cardoza also coordinated the activities of volunteers and students assisting, as well as observing in the GI service. He's encouraged each student and volunteer to shadow an assigned technician in order to learn their respective roles. Many of the students appreciated this special arrangement and commented to the Nurse and Assistant Nurse Managers that they learned a great deal through this observational training. Mr. Cardoza monitored the list of patients who had complications from procedures and coordinated their care and management, including arranging admissions. He assisted the Quality Improvement Coordinator in identifying the patients/cases that need a review at the divisional Quality Assurance/Improvement meeting. He also helped to find accommodations for the patient's family members. There are many factors that affect the efficient operations of the GI Endoscopy service; from patient no shows to late arrivals, inadequate bowel preparation, to MD tardiness and case cancellation. Mr. Cardoza is very good at tracking all the events and not afraid to meet with patients or providers to address some of the issues to minimize any problems or misunderstandings, as well as maintain a smooth and efficient service flow.