Automated tracking helps leave no incidental finding behind

Radiology researchers have developed and validated an automated program for tracking incidental imaging findings. The system facilitates communications between radiologists, patients and primary care providers whenever such findings turn up.  

The work was conducted at University of Illinois Hospital in Chicago and is described in Current Problems in Diagnostic Radiology. [1] 

Over an 18-month testing period, the program flagged 270 of 2,243 incidental findings from any imaging modality as needing a closer look, according to the study report. The alerts prompted notifications to go out from the radiology department, urging patients and, when applicable, their PCPs or referrers to pursue appropriate follow-up. 

Patients who were imaged in the ED and had no regular PCP were contacted within three days of the radiology report, receiving follow-up instructions via certified mail. 

Positive results of the program included early detection of pancreatic cancer and lung adenocarcinoma. 

In addition, some 84% of participating radiologists said they found the system easy to understand and use.

Electronic medical records meet incidental templates

Corresponding author James Bui, MD, and colleagues dubbed their problem “RAFT” for Radiology Actionable Findings Tracking. 

The team created a template specific to the program and incorporated it into the electronic medical record. The template captures and conveys key information from the reading radiologist on findings, acuity, communication status and general recommendations for follow-up.

Existing software automatically compiles this data into a spreadsheet, which is continuously monitored by a clinical coordinator. This team member is responsible for notifying the PCP or referring provider. 

Once follow-up action is documented, the system checks off the case as resolved. 

Streamlined communication for care escalation 

In their discussion, the authors cite prior research suggesting four strategies for managing incidental findings—reminders, templates, EMR integration and tailored communication pathways. 

The RAFT system “incorporates several of these strategies by providing a specific reporting template with reminders in the EMR and closed-loop communication with the PCP,” Bui and co-authors remark. 

Among the limitations the team acknowledges in RAFT are the inability to escalate care when an ED patient lacks a PCP and the possibility of patients leaving the ED before their final radiology read is available. 

“The communication of actionable incidental findings between a radiologist, a patient and their provider is critical but nuanced,” Bui and colleagues conclude. “The RAFT program was incorporated into the EMR to streamline the communication of incidental findings, and, to date, 270 patients have had significant incidental findings with care escalation who might otherwise be lost to follow-up.”

The authors suggest their project offers a model for other institutions to adopt as they see fit.