BMJ Open Quality (May 2019)
Process improvement for follow-up radiology report recommendations of lung nodules
Abstract
Problem Communication of imaging results and follow-up recommendations to patients and primary care providers (PCPs) is a challenge for healthcare systems. In addition, tracking whether a patient’s follow-up has been completed is another significant gap in care coordination. Patients are often unaware of or cannot even understand the significance of radiology findings or follow-up recommendations reported after imaging procedures. In addition, patients may not have a primary physician listed at time of imaging if the first encounter is in the emergency room (ER) or if their primary care physician or specialist works in a different electronic health record platform. Communication of imaging results to different healthcare providers is challenging with the myriad of existing electronic health record systems that often lack interoperability with other clinical entities.Description of lung nodules in radiology reports can vary widely if a standardised lexicon is not used. Moreover, follow-up recommendations by radiologists can be varied for certain size lung nodules because an individual’s risk factors to develop lung cancer may not be known at the time of dictation.Approximately 500 000 radiology imaging procedures are interpreted and performed annually by a single private group of 33 radiologists located at a 665-bed regional referral centre and at a 140-bed acute care community hospital, both located in the suburbs of a major metropolitan city. Management of this volume of patients in the health system can be overwhelming to nurse navigators, and there is usually no system in place for primary care physicians to follow-up lung nodules found unexpectedly on inpatient images. The goal of this project was to develop a better automated tracking method and communication tool to reduce the likelihood that needed follow-up studies are missed by patients and clinicians.