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Dustin Ballard, MD, MBE

Emergency Medicine, KP San Rafael

“Most research in emergency medicine is conducted at a single hospital or academic center, which may not be generalizable to other emergency departments. CREST conducts community-based research, so it has the potential for broader implications,” says Dr. Vinson, a CREST cofounder.

While most patients visiting the emergency department for chest or abdominal pain do not have a life-threatening condition like a heart attack or appendicitis, determining who is indeed at high risk and in need of urgent management can be a challenging clinical problem for the admitting physician.

To help support such clinical decision-making, a group of TPMG emergency medicine physicians in partnership with the KP Division of Research founded an innovative research network, called CREST, in 2008.

The CREST network comprises 11 clinician researchers who examine disease patterns and treatment outcomes using data from over 1.2 million annual visits to 21 emergency departments across KP Northern California. They then use  their findings to refine care protocols and build technologies that optimize patient management.

One of the major successes of the program has been the development of RISTRA, a risk stratification tool for conditions like pulmonary embolism, pediatric appendicitis, and acute coronary syndrome. For pulmonary embolisms, for example, RISTRA helps determine which patients are low risk and can be treated without hospital admission, which has resulted in a 60% increase in the rate of home discharge, with no increase in morbidity or mortality.

CREST researchers have published more than 100 articles in peer-reviewed journals in less than a decade, with subjects ranging from cardiac arrest and pediatric head trauma to ischemic stroke and atrial fibrillation.

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