Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings - 20/08/22
, Nicholas M. Garland, MS, Clifford L. Freeman, MD, Katharine Klar, BSN, RN, Jan Dahlke, RN, Penny Lancaster, BSN, RN, Larry Prisco, MSW, LCSW, Sam S. Chang, MD, MBA, Laura W. Goff, MD, Stephan Russ, MD, MPH, Ian D. Jones, MDAbstract |
Study objective |
Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record–based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance.
Methods |
Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete. The forms were routed to nurse case managers, who arranged follow-ups based on the findings and clinical significance. The primary outcome was the proportion of ED patient visits with identified incidental findings that had documented communication of the incidental findings and surveillance plans.
Results |
Over the first 13 months after implementation, 932 ED patient visits had critical radiology alert referrals, for a total of 982 incidental findings. The primary outcome (confirmed post-ED communication and documented follow-up plan) was attained in 888 (95.3%, 95% confidence interval [CI] 93.9% to 96.6%) ED patient visits with confirmed post-ED communication and documented follow-up plans. The team was unable to contact or confirm follow-up with 44 (4.7%, 95% CI 3.4 to 6.1) patients by telephone or through the health care system’s electronic communication tools.
Conclusion |
We report the implementation of a standardized notification and referral system for ED patients with incidental radiology findings. The development of a reliable notification and follow-up system is an important patient safety intervention given the opportunity to potentially identify undiagnosed malignancies.
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| Please see page 236 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: TWB, NMG, IDJ, LWG, SSC, and SR conceived the project and designed the intervention. TWB, CLF, KK, JD, PL, LP, SSC, and LWG supervised the conduct of the quality improvement initiative. IDJ, TWB, and SR developed the electronic health record enhancement. KK, JD, PL, and LP supervised and undertook referral of patients and quality control. TWB and CLF analyzed the data; ML chaired the data oversight committee. TWB, NMG, and CLF drafted the manuscript, and all authors contributed substantially to its revision. TWB takes responsibility for the paper in its entirety. |
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| All authors attest to meeting the 4 ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| Publication dates: Received for publication February 16, 2022. |
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| An abstract titled “Oncology Capture of ED Patients with Incidental Radiologic Findings” was presented at The Association of Community Cancer Centers 38th National Oncology Conference on Thursday, October 21, 2021, in Austin, Texas. |
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Vol 80 - N° 3
P. 235-242 - septembre 2022 Retour au numéro
Article précédent
- A Clinical Prediction Rule for Bacterial Musculoskeletal Infections in Children with Monoarthritis in Lyme Endemic Regions
- Todd W. Lyons, Anupam B. Kharbanda, Amy D. Thompson, Jonathan E. Bennett, Fran Balamuth, Michael N. Levas, Desiree N. Neville, David P. Lewander, Brianna S. Bretscher, Mark D. Kellogg, Lise E. Nigrovic, Pedi Lyme Net
- Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis
- Christopher S. Evans, Rodney Arthur, Michael Kane, Fola Omofoye, Arlene E. Chung, Elizabeth Moreton, Carlton Moore
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