Professor of Medicine
Harvard Medical School
“While this is just the beginning of the diagnostic learning journey, it has taken a true commitment by your faculty to implement our case review process—including ensuring approval by IRB, building and training their case review team, implementing workflows embedded into local culture/safety programs, and developing alliances with leaders in quality and safety at your hospital.”
A dedicated group of hospitalists are advancing diagnostic excellence under the leadership of Radha Devi, MD, and Timothy Evans, MD, through our Division’s Center for Diagnostic Excellence (DexEx). Currently this work focuses on three key areas:
1. Collaborating in the Hospital Medicine ReEngineering Network: Achieving Diagnostic Excellence Through Prevention and Teamwork (HOMERuN ADEPT) Team. Led by Radha Devi, MD, and Robert Young, MD, (site leads) and supported by doctors Monique Bruinsma, Timothy Evans, Safa Farrag, Katy Filson, Tracey Godbold, Hazera Khatun, Danielle Kubicki, Gina LaRossa, Han Li, Nathan Martin, Zachary Morgan, Brandon Parker, Kieran Patel, and Tong Yu. This team was recently recognized by ADEPT Study Co-Lead Jeffrey Schnipper, MD, MPH, for their outstanding work in actively surveilling the inpatient medicine population for diagnostic errors. Currently this group is actively involved in the development of the ADEPT Intervention bundles:
- Dr. Radha Devi is focusing on second opinions, “phone a friend,” and automatic consults.
- Dr. Timothy Evans is working on “Diagnostic Time Outs” to more consciously develop and re-evaluate diagnoses.
- Dr. Monique Bruinsma is improving Epic navigation to reduce testing gaps and enhance assessment skills.
- Dr. Robert Young and Dr. Kieran Patel are working on communication and patient activation interventions.
2. Enhancing diagnostic accuracy and accelerating innovation. A working group composed of master diagnosticians, health literacy and communication experts, and operational leaders aims to develop a program using AHRQ’s CalibrateDx platform. CalibrateDx is a self-evaluation tool for clinicians to improve their diagnostic decision making. The team will integrate meta-cognition, health literacy, and enhanced patient/family caregiver communication to create a unique approach that includes the entire health care team with the patient at the center.
3. Developing our DexEx’s center in collaboration with Colorado’s Institute for Healthcare Quality, Safety and Efficiency (IHQSE). Timothy Evans, MD, and Radha Devi, MD, are building the diagnostic excellence infrastructure here at WashU. They are currently developing systems aimed at enhancing patient outcomes, building a compelling case for diagnostic safety, integrating with the existing quality improvement/patient safety infrastructure, and fostering a culture of diagnostic excellence through change management strategies. Their work is laying the foundation for a sustainable, high-impact platform to deliver innovative diagnostic interventions like ADEPT and CalibrateDx—benefiting both our local healthcare community and healthcare delivery nationally. Assisting Dr. Tim Evans and Dr. Radha Devi with the development of the DexEx center are doctors Monique Bruinsma, Kim Crouse, Safa Farrag, Katy Filson, Tracey Godbold, Eric Johnson, Hazera Khatun, Brandon Parker, Kieran Patel, and Rob Young.
Jeffrey Schnipper, MD, MPH, ADEPT Study Co-Lead, stated, “I wanted to send you a brief note from the ‘Achieving Diagnostic Excellence through Prevention and Teamwork’ (ADEPT) Study leadership team to highlight and recognize the stellar group of people we have had the opportunity to work with at WashU St. Louis…While this is just the beginning of the diagnostic learning journey, it has taken a true commitment by your faculty to implement our case review process—including ensuring approval by IRB, building and training their case review team, implementing workflows embedded into local culture/safety programs, and developing alliances with leaders in quality and safety at your hospital.”