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Incidental Isn’t Inconsequential – How to Follow Up Incidental Findings on Radiographs

October 24, 2022

Written by Ketan Patel

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A novel comprehensive methodized process is presented for the proper disclosure of incidental findings on ED imaging and for ensuring proper follow up and subsequent management.

Why does this matter?
Incidental findings on imaging studies – unrelated to a patient’s current visit – are not only common, a significant percentage of these findings (6 to 27%) can be first diagnoses, harbingers of malignancy. Lack of disclosure or inappropriate follow up leads to medico-legal pitfalls for providers and poor outcomes for patients.

Narrowing holes in the safety net
This was a retrospective cohort to analyze the implementation of a quality improvement process for the handling of incidental findings in a busy hospital system. The hospital system created a novel critical radiology alert system that used a multidisciplinary approach to link incidental findings on ED studies to an established protocol for disclosure and follow up.

In implementation of this process, they were able to utilize nuances of the electronic health record for reliable notification of findings, and subsequent acknowledgement of these findings by the ED staff. By then integrating a process for referrals, they were able to reliably obtain follow up for these patients.

In their cohort of 982 incidental findings, they were able to attain their primary outcome, which was communication of the incidental finding with the patient and a surveillance plan in place, 95.3% of the time (888 patients). The largest group unable to be contacted were out-of-network patients.

This comprehensive system certainly reached its goal and attained its primary outcome in a majority of patients in comparison to other protocols previously published. It also utilized nuances in the electronic health record for proper communication and tracking.

If you’re interested in the standard operating procedure used, here is a the same image used in the article – on the VUMC site.

Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med. 2022 Sep;80(3):235-242. doi: 10.1016/j.annemergmed.2022.04.026. Epub 2022 Jun 23.

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