Implementation of a Standardized Template for Reporting of Incidental Pulmonary Nodules: Feasibility,Acceptability, and Outcomes |
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| Affiliation: | 1. University of Minnesota School of Public Health, Minneapolis, Minnesota;2. Section of Pulmonary, Allergy Sleep and Critical Care, Minneapolis VA Health Care System, Minneapolis, Minnesota;3. Department of Radiology, Iowa City VA Health Care System, Iowa City, Iowa;4. Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota School of Medicine, Minneapolis, Minnesota;5. Primary Care Service Line, Minneapolis VA Health Care System, Minneapolis, Minnesota;1. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Radiology, Pennsylvania Hospital, Philadelphia, Pennsylvania;1. AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l''Appareil Digestif (PMAD), DHU Unity, Clichy, France;2. Université Paris Diderot, Paris, France;3. Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Clichy, France;4. AP-HM, Hospital Timone, EA3279 Self-perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Marseille, France;5. AP-HP, Hôpital Beaujon, Department of Gastroenterology, Pôle des Maladies de l''Appareil Digestif (PMAD), DHU Unity, Clichy, France;6. AP-HP, Hôpital Beaujon, Department of Radiology, Clichy, France;1. Department of Surgery, Duke University, Durham, North Carolina;2. Duke University School of Medicine, Durham, North Carolina;3. Duke Translational Medicine Institute Biostatistics Core, Durham, North Carolina;1. Department of Radiology, New York University School of Medicine, New York, New York;2. Department of Population Health, New York University School of Medicine, New York, New York;1. Department of Medicine, Division of Endocrinology, St. Paul''s Hospital & University of British Columbia, Vancouver, BC, Canada;2. Department of Surgery, St. Paul''s Hospital & University of British Columbia, Vancouver, BC, Canada;3. Department of Radiology, St. Paul''s Hospital & University of British Columbia, Vancouver, BC, Canada |
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| Abstract: | ObjectiveIncidental pulmonary nodules (IPNs) are common. Up to 70% are not followed up according to current guidelines. Follow-up recommendations are based on the characteristics of the patient and the IPN. However, many IPNs are incompletely characterized in CT reports. Structured radiology reports have been shown to reduce missing information. We sought to improve IPN reporting by assessing the feasibility, acceptability, and effectiveness of a structured dictation template to increase the presence of six key nodule descriptors.MethodsWe performed a mixed methods, pre- and postimplementation assessment. A template was developed with a multidisciplinary group based on Fleischner Society guidelines. A standardized checklist was used to determine the presence of documented descriptors pre- and postimplementation for sequential radiology reports of patients with an IPN present (n = 400 pre-implementation and n = 400 postimplementation) on a CT performed at the Minneapolis Veterans Affairs Health Care System. We conducted qualitative interviews with radiologists (n = 4) and members of the lung nodule tracking team (n = 2) to elicit their experiences of the template implementation process.ResultsThe proportion of radiology reports including all six elements increased from 12% to 47% (P < .001). Postimplementation, the template was used in 40% of interpretations involving lung nodules, 67% of follow-up scans, and 8% of initial identifications. Response to the template was overall positive.DiscussionUse of a dictation template seems to be effective in increasing compliance with full IPN documentation, streamlining the follow-up process. Low utilization rates of the template for initial nodule identification is a limitation, which may be combated through clearer communication and advances in technology. |
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| Keywords: | Fleischner Society guidelines incidental pulmonary nodule process implementation standardized reporting |
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