Paul Nadler, MD
Professor
Medicine
School of Medicine

In this role, I organize, plan, and provide clinical care in the UCSF Screening and Acute Care Clinic (annual patient volume of approximately 16,000 prior to COVID-19). I have developed protocols for triage of patients, trained LVNs and RNs in effective triage, established the pattern of routine and emergent patient flow, implemented a same-day telephone and web-based appointment system, and established patient scheduling administrative procedures. I take a leading role in physician scheduling, as well as the recruitment and training of physicians and nurse practitioners for work in acute care. I participate actively in defining the scope of service and developing equipment and medication supply lists. I have established protocols for routine referral, urgent referral, and transfers to the ED. To ensure consistency and quality of care, I wrote and disseminated an orientation and training manual, and directly supervise clinical care provided by three nurse practitioners on an on-going basis. We have conducted several research studies to improve clinical care in the acute setting. I also regularly provide bedside teaching and precepting to housestaff and students, and the Screening and Acute Care Clinic actively participates in the PISCES medical student education program. I also provide general medicine training to interns from obstetrics and gynecology. To integrate our teaching mission with our patient care services, I serve as the liaison to these programs and participate in organizing the scheduling. I regularly review charts for appropriate documentation of medical care and the level of coding. I take a lead role in evaluating any issues related to the quality of care as raised by patients, colleagues, or from cases forwarded to me from UCSF Patient Relations. During the transition to the APeX electronic medical record, I developed internal workflows to coordinate the SACC front desk with triage nurse patient evaluation, and designed systems for clinicians to notify our nurses to process medical orders. I also trained as an APeX “superuser” and took a lead role in the training of SACC clinicians in the new system, as well as developing and implementing productivity standards, and norms of documentation and billing. Working with Ralph Gonzales, MD, we implemented a tablet computer-based registration system for patients (Phreesia) that also runs clinical treatment modules that expedite the management of recurrent uncomplicated UTI, and sinusitis. These modules reduce patient wait-time, increase clinical efficiency, and are based on evidence-based standards of care. SACC has embraced the LEAN management system being implemented at UCSF. I am the medical leader of the SACC Unit Based Leadership Team, and I am working on several people and performance projects with the Quality Improvement Specialist, and Administrative Leader.

In 2017, I began providing "video visits" (tele-health) in SACC for patients initially seen in-person in urgent care and needing follow-up to assess for clinical improvement. I developed the appropriate scheduling and patient technological education to support this service.

2018-present- Medical Director, UCSF Adult Acute Care. In this capacity, I continue my clinical care, leadership and coordination of the Screening and Acute Care Clinic while working with the ED on the development of an advance urgent care facility at Mission Bay. 2020- Medical Director, UCSF Respiratory Screening Clinics. In response to the COVID-19 pandemic, I was asked by UCSF Health to open three respiratory screening clinics (RSCs) to meet demand for safe and efficient evaluation and treatment of staff and patients infected with COVID-19 or suspected of having COVID-19. In this role, I provide clinical care, worked with DGIM administrative leadership and stood-up a safe clinical environment for our patients, and appropriate testing protocols for patients referred from UCSF Population Health or primary care, or specialty clinics for COVID-19 testing of symptomatic patients. I took an active role in training clinicians and registered nurses in COVID-19 testing and care, as well as appropriate PPE donning and doffing and specimen handling. I directly provide patient evaluation and clinical care for patients under investigation for COVID-19, as well as confirmed cases. I also actively participate in multiple meetings with UCSF Health Leadership and administration to develop appropriate clinical care and patient flow guidelines. I also interact with the specialty practices to ensure support of pre-procedural COVID-19 testing. I take a lead role in facilitating outpatient studies and medication trials conducted by researchers at the Respiratory Screening Clinics. In December, working with my colleagues, we developed a protocol to provide the monoclonal ab Bamlanivimab by infusion to eligible COVID positive patients.