Dana Sax , MD

dana.r.sax@kp.org

Sax, Dana

Dana Sax, MD, is senior physician with The Permanente Medical Group (TPMG), practicing emergency medicine at the Oakland, Richmond, and San Rafael medical centers, and adjunct investigator with the Division of Research. She is a member of the Physician Researcher Program managed by TPMG’s Delivery Science & Applied Research program.

Dr. Sax joined TPMG in 2013 and sought opportunities to pursue research in emergency medicine, with a particular interest in using large datasets to understand public health and clinical challenges. She joined the Clinical Research on Emergency Services and Treatments (CREST) Network, a multi-center collaborative network headquartered at the Division of Research that encourages, enables, and executes research in emergency medicine.

Her research has focused on use of Kaiser Permanente’s rich electronic health records to study a variety of emergency conditions and care delivery strategies. She has a particular interest in developing ways to better predict risk among patients in the emergency department and have studied how innovations in technology and care delivery can promote more personalized, safer, and higher value care.

Dr. Sax received her MD from Robert Wood Johnson Medical School in Piscataway, N.J., and did her medical residency at Georgetown University Hospital and Washington Hospital in Washington, D.C.

Studies

Safety and Operational Impacts of Emergency Department Mis-Triage

In this study we will broadly characterize the potential safety and operational implications of under- and over-triage among adult and pediatric patients. We will conduct a sub-analysis specifically among patients with an emergency department diagnosis of severe sepsis or septic shock, for whom delays in care are associated with worse outcomes.

Investigator: Sax, Dana

Funder: Northern California Community Benefit Programs

Improving safety and quality of emergency care using machine learning-based clinical decision support at triage

Using a dataset of over 6 million ED encounters across 21 KPNC medical centers, we will use machine-learning methods to develop triage models that predict critical illness, hospital admission, and fast-track eligibility among pediatric and adult patients. We will incorporate unstructured data, identify clinically relevant probability thresholds for each outcome, and validate the models on a retrospective dataset to assess predictive accuracy and then prospectively in the EHR. We will pilot test at 2 EDs to assess feasibility, incorporating stakeholder engagement. Lastly, we plan a pragmatic, step-wedge trial to study the impact of the tool on safety and accuracy of triage predictions, disparities in triage predictions, ED length of stay, and nursing acceptance and adoption of the tool.

Investigator: Sax, Dana

Funder: Agency for Healthcare Research and Quality

Publications

Automated analysis of unstructured clinical assessments improves emergency department triage performance: A retrospective deep learning analysis

Authors: Sax, Dana R;Warton, E Margaret;Sofrygin, Oleg;Mark, Dustin G;Ballard, Dustin W;Kene, Mamata V;Vinson, David R;Reed, Mary E

J Am Coll Emerg Physicians Open. 2023 Aug;4(4):e13003. Epub 2023-07-12.

PubMed abstract

Clinical decision support to Optimize Care of patients with Atrial Fibrillation or flutter in the Emergency department: protocol of a stepped-wedge cluster randomized pragmatic trial (O’CAFÉ trial)

Authors: Vinson, David R;Zhang, Jennifer Y;Ballard, Dustin W;Lin, James S;Kwok, Edward W;Solomon, Matthew D;Go, Alan S;Kaiser Permanente CREST Network,;et al.

Trials. 2023 Mar 31;24(1):246. Epub 2023-03-31.

PubMed abstract

Evaluation of the Emergency Severity Index in US Emergency Departments for the Rate of Mistriage

Authors: Sax, Dana R; Mark, Dustin G; Vinson, David R; Ballard, Dustin W; Reed, Mary E; Kaiser Permanente CREST (Clinical Research on Emergency Services & Treatments) Network,; et al.

JAMA Netw Open. 2023 Mar 01;6(3):e233404. Epub 2023-03-01.

PubMed abstract

Barriers and Opportunities Regarding Implementation of a Machine Learning-Based Acute Heart Failure Risk Stratification Tool in the Emergency Department

Authors: Sax, Dana R; Sturmer, Lillian R; Mark, Dustin G; Rana, Jamal S; Reed, Mary E

Diagnostics (Basel). 2022 Oct 11;12(10). Epub 2022-10-11.

PubMed abstract

Current Emergency Department Disposition of Patients With Acute Heart Failure: An Opportunity for Improvement

Authors: Sax, Dana R; Mark, Dustin G; Rana, Jamal S; Reed, Mary E; Lindenfeld, Joann; Stevenson, Lynne W; Storrow, Alan B; Butler, Javed; Pang, Peter S; Collins, Sean P

J Card Fail. 2022 10;28(10):1545-1559. Epub 2022-05-29.

PubMed abstract

Risk adjusted 30-day mortality and serious adverse event rates among a large, multi-center cohort of emergency department patients with acute heart failure

Authors: Sax, Dana R; Mark, Dustin G; Rana, Jamal S; Collins, Sean P; Huang, Jie; Reed, Mary E; CREST Network,

J Am Coll Emerg Physicians Open. 2022 Jun;3(3):e12742. Epub 2022-06-09.

PubMed abstract

Higher intensity of 72-hour non-invasive cardiac test referral does not improve short-term outcomes among emergency department patients with chest pain

Authors: Mark, Dustin G; Shan, Judy; Huang, Jie; Ballard, Dustin W; Vinson, David R; Kene, Mamata V; Sax, Dana R; Rauchwerger, Adina S; Reed, Mary E; Kaiser Permanente CREST Network Investigators,

Acad Emerg Med. 2022 06;29(6):736-747. Epub 2022-02-23.

PubMed abstract

Downstream Acute Care Utilization Following Initial Prescription of an Opioid Pain Reliever Among Emergency Department Patients With Low-Severity Conditions

Authors: Juergens, Nathan; Wei, Julia; Cullen, Esme; Graubard, Moses; Gupta, Vibha K; Weintraub, Miranda Ritterman; Sax, Dana

Perm J. 2022 Apr 05;26(1):47-56. Epub 2022-04-05.

PubMed abstract

Graded Coronary Risk Stratification for Emergency Department Patients With Chest Pain: A Controlled Cohort Study

Authors: Mark, Dustin G; Ballard, Dustin W; Sax, Dana R; Vinson, David R; Reed, Mary E; Kaiser Permanente CREST Network Investigators [Link],; et al.

J Am Heart Assoc. 2021 11 16;10(22):e022539. Epub 2021-11-06.

PubMed abstract

Clinical characteristics of COVID-19 patients evaluated in the emergency department: A retrospective cohort study of 801 cases

Authors: Cotton, Dale M; Vinson, David R; Ballard, Dustin W; Sax, Dana R; Mark, Dustin G; Reed, Mary E; Clinical Research on Emergency Services and Treatment (CREST) Network,; et al.

J Am Coll Emerg Physicians Open. 2021 Aug;2(4):e12538. Epub 2021-08-23.

PubMed abstract

Health care utilization outcomes after implementation of early peanut introduction guidelines

Authors: Ko, Jimmy; Zhu, Shiyun; Alabaster, Amy; Wang, Julie; Sax, Dana R

J Allergy Clin Immunol Pract. 2021 01;9(1):531-533.e1. Epub 2020-09-08.

PubMed abstract

Prehospital Treatment and Emergency Department Outcomes in Young Children with Food Allergy

Authors: Ko J; Zhu S; Alabaster A; Wang J; Sax DR

J Allergy Clin Immunol Pract. 2020 Jul - Aug;8(7):2302-2309.e2. Epub 2020-04-14.

PubMed abstract

Couples Match in Emergency Medicine

Authors: Kindermann D; Coates WC; Deiorio N; Collins RW; Mattu A; Cheaito MA; Lotfipour S; Kazzi A

J Emerg Med. 2019 Oct 05.

PubMed abstract

What Accountable Care Organizations Can Learn from Kaiser Permanente California’s Acute Care Strategy

Authors: Selevan J; Kindermann D; Pines JM; Fields WW

Popul Health Manag. 2015 Aug;18(4):233-6. Epub 2015-04-09.

PubMed abstract

The transfer instability index: a novel metric of emergency department transfer relationships

Authors: Kindermann DR; Mutter RL; Houchens RL; Barrett ML; Pines JM

Acad Emerg Med. 2015 Feb;22(2):166-71. Epub 2015-01-29.

PubMed abstract

Emergency department transfers and transfer relationships in United States hospitals

Authors: Kindermann DR; Mutter RL; Houchens RL; Barrett ML; Pines JM

Acad Emerg Med. 2015 Feb;22(2):157-65. Epub 2015-01-29.

PubMed abstract

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