David R. Vinson , MD

david.r.vinson@kp.org

David R. Vinson, MD, is an adjunct investigator at the Kaiser Permanente Division of Research and a practicing emergency physician at the Kaiser Permanente Roseville and Sacramento medical centers. He has served as the research chair at the Kaiser Permanente Roseville Medical Center for over 15 years. Dr. Vinson has been part of the Permanente Medical Group Physician Researcher Program since 2017.

In 2008 he co-founded the KP CREST Network, a collaborative of clinical researchers in Kaiser Permanente with personnel from the Division of Research. Its members seek to improve the care of children and adult patients evaluated in the emergency department. He has served as the co-chair of the CREST Network since 2012.

In addition, he is a volunteer clinical faculty at UC Davis Health in Sacramento, where he mentors medical students and residents. He is also Clinical Associate Professor of Clinical Research and Emergency Medicine, California Northstate University College of Medicine in Elk Grove. He serves on the Low-risk Pulmonary Embolism and Deep Vein Thrombosis Expert Panel for the American College of Emergency Physicians.

His current research interests include observational studies and implementation research across a broad range of clinical conditions, including pulmonary embolism, atrial fibrillation, syncope and COVID-19.

Dr. Vinson earned his MD at University of California, Davis, after completing his BS at University of California, Berkeley. His first residency was in family medicine with a UC Davis Health affiliate program in Modesto, California. Upon completion, he stayed on as Assistant Professor of Family Medicine, training residents in primary care and emergency medicine. His second residency was in emergency medicine at the University of Washington in Seattle, after which he moved to the Sacramento region and joined the medical group in 1999.

Studies

Antenatal pulmonary embolism diagnostics (APED) in the COVID-19 era

Our multispecialty team will utilize the Kaiser Permanente Northern California (KPNC) Perinatal Obstetrics Database to identify approximately 1,500 gravid patients undergoing pulmonary embolism (PE) diagnostics in the COVID-19 era. We will describe the patients undergoing diagnostic testing for PE, what clinical settings and specialists are involved, and the diagnostic strategies undertaken and their outcomes. Results of this large, contemporary community-based study will fill gaps in the literature and inform next steps within KPNC to improve our antenatal PE diagnostic guidelines and direct physician education efforts.

Investigator: Vinson, David

Funder: KP National Office of Community Health

Reducing Variation in Hospitalization and Processes of Care in Emergency Department Patients with Atrial Fibrillation: A Stepped Wedge Cluster Randomized Trial

This stepped-wedge cluster randomized trial will stagger implementation of a clinical decision support system (CDSS) across 13 KPNC emergency departments to assist emergency physicians and hospitalists in the comprehensive management of patients with atrial fibrillation/flutter. We will compare hospitalization rates, processes of care, and stroke prevention actions between emergency departments with and without the CDSS intervention.

Investigator: Vinson, David

Funder: TPMG Delivery Science Projects Program

Optimal Anticoagulation Strategies for Acute Atrial Fibrillation

The purpose of this project is to assess the variation and impact of oral anticoagulant prescribing in the emergency department in order to inform development of interventions to improve acute atrial fibrillation and flutter management. A longitudinal database will be constructed that links claims from inpatient facility services, outpatient services, physician services, and pharmacy services from Kaiser Permanente members with a new emergency department diagnosis of atrial fibrillation from 2010 to 2017, with the following aims: 1) Describe magnitude and reasons for the practice gap in acute oral anticoagulation prescribing for oral anticoagulant-naive patients with an emergency department diagnosis of atrial fibrillation or atrial flutter, and 2) Assess the impact of acute oral anticoagulant prescribing in naive atrial fibrillation and flutter patients on clinical outcomes.

Investigator: Vinson, David

Funder: National Heart, Lung, and Blood Institute

Improving Stroke Prevention for High-risk Atrial Fibrillation by Discharge Redesign Using Electronic Clinical Decision Support

This is a retrospective cohort study to describe the effect of adding direct oral anticoagulants to the Kaiser Permanente formulary on overall rates of oral anticoagulant initiation at the time of discharge for emergency department and inpatients with high-risk non-valvular atrial fibrillation or flutter across 21 medical centers from 2010-2017. The results of this study will inform the design of an electronic clinical decision support tool to aid emergency physicians and hospitalists in the comprehensive management of patients with atrial fibrillation or flutter. The tool will include evidence-based guidance on rate reduction, cardioversion, and stroke prevention. The tool will be evaluated in a pilot study at three large Kaiser Permanente medical centers in Northern California. If the tool improves outcomes of patient care, expansion of tool access across the region for further study will be considered.

Investigator: Vinson, David

Funder: The Permanente Medical Group

Publications

CA FIRST (California Febrile Infant Risk Stratification Tool) Algorithm Development in a Learning Health System

Authors: Greenhow, Tara L;Alabaster, Amy;Vinson, David R;Sharp, Adam L;Rauchwerger, Adina S;Ballard, Dustin W;et al.

Perm J. 2023 Sep 15;27(3):92-98. Epub 2023-08-10.

David R. Vinson , MD

Studies

Antenatal pulmonary embolism diagnostics (APED) in the COVID-19 era

Reducing Variation in Hospitalization and Processes of Care in Emergency Department Patients with Atrial Fibrillation: A Stepped Wedge Cluster Randomized Trial

Optimal Anticoagulation Strategies for Acute Atrial Fibrillation

Improving Stroke Prevention for High-risk Atrial Fibrillation by Discharge Redesign Using Electronic Clinical Decision Support

Publications

CA FIRST (California Febrile Infant Risk Stratification Tool) Algorithm Development in a Learning Health System

Bilateral Emboli and Highest Heart Rate Predict Hospitalization of Emergency Department Patients With Acute, Low-Risk Pulmonary Embolism

Barriers and Facilitators to the Outpatient Management of Low-risk Pulmonary Embolism From the Emergency Department

Prevalence of and Eligibility for Surveillance Without Anticoagulation Among Adults With Lower-Risk Acute Subsegmental Pulmonary Embolism

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

Letter to the editor: “Clinical controversies in the management of acute pulmonary embolism”

CT Use Reduction In Ostensive Ureteral Stone (CURIOUS)

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)

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

Review of Pulmonary Embolism

Risk of venous thromboembolism in non-respiratory and respiratory presentations of COVID-19 in critically ill patients

Bilateral Tubal Pregnancies Presenting 11 Days Apart: A Case Report

Risk of posthospital venous thromboembolism in patients with COVID-19 varies by SARS-CoV-2 period and vaccination status

CTEPH: A Kaiser Permanente Northern California Experience

Atrial fibrillation triggered by cold drinks: increasing clinician and patient awareness

A Case Report of Cold Drinks and Food as a Trigger of Paroxysmal Atrial Fibrillation

Using AAP Guidelines for Managing Febrile Infants Without C-Reactive Protein and Procalcitonin

Management and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort Study

Pulmonary Embolism

Ten Additional Cases of Atrial Fibrillation Triggered by the Sequence of Strenuous Exercise and Cold Drink

Young woman with black spots and a red rash on her forearm

Clinical management and outcomes for febrile infants 29-60 days evaluated in community emergency departments

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

Sustainability of a Clinical Decision Support Intervention for Outpatient Care for Emergency Department Patients With Acute Pulmonary Embolism

Haloperidol Versus Ziprasidone With Concomitant Medications and Other Predictors of Physical Restraint Duration in the Emergency Department

Echocardiography for risk stratification in patients with pulmonary embolism at low risk of death: a response

Challenges in Managing Isolated Subsegmental Pulmonary Embolism

Adult Suicide-Related emergency department encounters during the COVID-19 Pandemic: a Cross-Sectional study

Adult Suicide-Related emergency department encounters during the COVID-19 Pandemic a Cross-Sectional study

A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: Results from a multidisciplinary consensus panel

Emergency Department Encounters Among Youth With Suicidal Thoughts or Behaviors During the COVID-19 Pandemic

Computed Tomography Use in Children With Minor Head Trauma Presenting to 21 Community Emergency Departments Within an Integrated Health-Care System

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

Imaging in suspected ureteral colic: Creating new decision rules based on multispecialty consensus

Right ventricle assessment in patients with pulmonary embolism at low risk for death based on clinical models: an individual patient data meta-analysis

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

“Outpatient Management” of Pulmonary Embolism Defined in the Primary Literature: A Narrative Review

Comprehensive management of acute pulmonary embolism in primary care using telemedicine in the COVID-era

Overcoming barriers to outpatient management of emergency department patients with acute pulmonary embolism

Effect of Clinical Decision Support on Diagnostic Imaging for Pediatric Appendicitis: A Cluster Randomized Trial

Predictors of Acute Atrial Fibrillation and Flutter Hospitalization across 7 U.S. Emergency Departments: A Prospective Study

Effect of Using an Age-Adjusted D-dimer to Assess for Pulmonary Embolism in Community Emergency Departments

Publication Non Grata: The Challenge of Publishing Non-COVID-19 Research in the COVID Era

Primary care physicians comprehensively manage acute pulmonary embolism without higher-level-of-care transfer: A report of two cases

Managing acute pulmonary embolism in primary care in a patient declining emergency department transfer: a case report

Emergency department cardioversion of acute atrial fibrillation

Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge

Comprehensive Outpatient Management of Low-Risk Pulmonary Embolism: Can Primary Care Do This? A Narrative Review

Neodymium Magnetic Bead Ingestion in a Toddler

Redressing Underrecognition of “Cold Drink Heart”: Patients Teaching Physicians about Atrial Fibrillation Triggered by Cold Drink and Food

Changing U.S. guidelines on lidocaine for stable monomorphic ventricular tachycardia: Have emergency medical services kept pace?

Detecting right ventricular dysfunction in patients diagnosed with low-risk pulmonary embolism: is routine computed tomographic pulmonary angiography sufficient?

Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting

Outpatient Management of Patients With Pulmonary Embolism

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation

Implementation of a Clinical Decision Support System for Children With Minor Blunt Head Trauma Who Are at Nonnegligible Risk for Traumatic Brain Injuries

Improving first shock success in patients with atrial fibrillation undergoing electrical cardioversion

Development of a Clinical Decision Support System for Pediatric Abdominal Pain in Emergency Department Settings Across Two Health Systems Within the HCSRN

Discriminatory value of the ascending aorta diameter in suspected acute type A aortic dissection

ECG Diagnosis: Acute Myocardial Infarction in a Ventricular-Paced Rhythm

ECG Diagnosis: Brugada Syndrome

ECG Diagnosis: Ibutilide-induced Torsade de Pointes

Increasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism: A Controlled Pragmatic Trial

Feasibility of expanded emergency department screening for behavioral health problems

Emergency Department Patient Satisfaction with Treatment of Low-risk Pulmonary Embolism

Enlisting Emergency Medicine Clinicians to Help Reduce Strokes in High-Risk Patients With Atrial Fibrillation and Flutter

Improving an Outpatient Pathway for the Emergency Management of Atrial Fibrillation and Flutter

Clinical Judgment and the Pediatric Emergency Care Applied Research Network Head Trauma Prediction Rules

Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma: A Mixed-Methods Study

Stroke Prevention for High-Risk Atrial Fibrillation in the Emergency Setting: Differences Between Canada and the United States

Outpatient Management of Emergency Department Patients With Acute Pulmonary Embolism: Variation, Patient Characteristics, and Outcomes

Feasibility of single- vs two-physician procedural sedation in a small community emergency department

Impact of emergency physician-provided patient education about alternative care venues