MacNeal Hospital has been using the Isabel clinical reasoning tool since 2008 with their 600 clinician users. As a 427-bed fully accredited teaching hospital, MacNeal Hospital serves the healthcare needs of more than one million people in suburbs of Chicago, Illinois.
Why MacNeal Hospital Chose Isabel Healthcare
The MacNeal Hospital clinicians and Dr. Charles Bareis first discovered the Isabel Healthcare clinical reasoning tool when their clinical book club read the book How Doctors Think by Jerome Groopman, MD. Reading and discussing the book caused the group of doctors to think about what they could do differently with patients to improve care.
Misdiagnosis is not a typical topic discussed among physicians, and as Dr. Bareis noted, “Doctors do not make a practice of talking about the diagnosis they missed.” However, in this group, they began to talk about it, and they came to a common understanding that they needed a level of humility to improve care quality and possibly make some breakthrough improvements for their patients.
Initial MacNeal Hospital Challenges
MacNeal Hospital sought a solution for diagnosis that would be electronically-based, innovative and with a high reliability. With the goal of moving away from print-based research, the MacNeal team wanted their teaching hospital to have the best and most innovative resources to teach their new doctors and they wanted those tools to permeate the hospital.
When they had begun using Isabel, Dr. Bareis was responsible for MacNeal Hospital’s Library Services department. The team aimed to migrate to electronic research materials, and Isabel was the computer-based clinical reasoning tool they chose for their physicians. Before installing the Isabel tool, the staff relied partially on the Internet/Google or electronic clinical resources for their diagnosis and medical research.
The doctors had frank discussion among themselves regarding cases they were involved in which had missed or delayed diagnosis, and they felt it was advantageous to use Isabel for clinical reasoning throughout the hospital. No other tools were considered to have the capabilities of Isabel, so they decided to implement Isabel for all 600 physicians.
Dr. Bareis noted that their physicians and staff need Isabel, “primarily because no one can keep all the information in their heads.” Relying on Isabel for the most current diseases and clinical information has strengthened their clinical care, giving reassurance to physician, patients and their families.
MacNeal Hospital Patient Case Example
An older retired attorney presented with weight loss and hypotension, he was hypothermic, had a normal thyroid, and was not hyperadrenal; the patient seemed to have a case of the “dwindles,” meaning that he was not sick enough for hospice, but he was not getting better. The MacNeal physician consulted Isabel for assistance. Neuromuscular disease appeared on the Isabel checklist as a possible disease.
The patient had been previously diagnosed with hereditary proximal myopathy. When the physician researched hereditary proximal myopathy, he discovered that a patient could become hypothermic. This symptom is rare, and in fact, a neurology consult missed this point; however the physician was able to determine the cause.
The final outcome was that nothing could be done to help this patient in the end stages of his life; however, the physician reported that reaching the correct diagnosis gave the patient’s family great relief to understand the condition so they could treat the symptoms and not worry about other causes.
Benefits of Isabel at MacNeal Hospital
Training New Staff: Isabel helps MacNeal Hospital train its new staff, as they use the Isabel tool to guide new residents and mentor new physicians on their rounds.
Reassurance: Many of the 600 physicians actively use Isabel during their patient consults, and they note that Isabel is an instrumental tool that helps reassure the physician as well as the patient and patient’s family.
Validation Against Malpractice: Located in Cook County, MacNeal Hospital is a misdiagnosis litigation “hot spot,” and has some of the highest malpractice litigation rates in the United States. The MacNeal Hospital team finds using Isabel helpful from a validation perspective for their patient cases, and physicians often print the results from Isabel to place in patient records.