System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings |
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| Affiliation: | 1. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;1. Department of Internal Medicine, Kettering Health Network, Kettering, Ohio; and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia;2. Chair, Department of Radiology, University of Mississippi Medical Center, Jackson, MS; and Member, Board of Chancellors, ACR;1. Department of Radiology, Henry Ford Health System, Detroit, Michigan;2. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia;3. Department of Radiology, Children''s Healthcare of Atlanta-Egleston, Atlanta, Georgia;4. Department of Radiology, University of Chicago, Chicago, Illinois;1. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;2. Harvard Medical School, Boston, Massachusetts;3. Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts;4. Lahey Hospital and Medical Center, Burlington, Massachusetts;1. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Director, Center for Translational Imaging Informatics, Perelmen School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;4. Vice Chairman, Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania;5. Associate Professor, Co-director, Automated Radiology Recommendation Tracking Engine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania |
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| Abstract: | The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method. We assembled a multidisciplinary team to address the nature of these incidental findings and designed new workflows and operational pathways for both radiology and ED staff to properly communicate incidental findings. Our results are based on all incidental findings received and acknowledged between November 1, 2016, and May 30, 2017. The total number of incidental findings discovered was 1,409. Our systematic compliance fluctuated between 45% and 95% initially after implementation. However, after overcoming various challenges through optimization, our system reached a compliance rate of 93% to 95%. Through the implementation of our new, standardized communication system, a high degree of compliance with loop closure for ED incidental radiology findings was achieved at our institution. |
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| Keywords: | Incidental findings communication system implementation patient safety emergency department radiology |
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