Radiology resident-led quality improvement project boosts incidental findings follow-up rate
A group of radiology residents has developed a system capable of significantly improving follow-up adherence for incidental thyroid nodules.
The team built on their organization’s modified dictation template that already included a pick-list of options for readers’ nodule management recommendations. Though the template provided all the information necessary for follow-up, the group discovered through a quality improvement initiative that this information often was not relayed to the appropriate party—a common occurrence with incidental findings.
“Incidental thyroid nodules are frequently detected during unrelated imaging studies and an estimated 4% are potentially malignant,” Soonmee Cha, MD, with the Department of Radiology & Biomedical Imaging at University of California, San Francisco, and colleagues explained. “The American College of Radiology provides guidelines for [incidental thyroid nodule] characterization and follow-up, but awareness and adherence are inconsistent.”
After their discovery, residents created a monthly audit system to identify nodules that were not known to referring providers within their network. They also initiated closed loop communications through the EHR with said providers who required documented acknowledgement of the findings and recommendations. The system required that referrers be notified of the findings via a secure HIPAA-compliant message. The team compared rates of follow-up adherence and communications before and after the audit system was implemented to determine its utility.
They observed a significant improvement in primary care physician awareness, which increased from 75% to 98%. This resulted in a 19% uptick in patients completing their recommended follow-up ultrasounds. Inevitably, these changes also triggered a spike in fine needle aspiration rates, but the group did not deem this change as statistically significant.
The authors believe their findings underscore the “efficacy of structured reporting and targeted communication strategies in mitigating missed diagnoses and facilitating timely patient care.”
“The techniques we piloted for this study could be adopted in part or whole by other practices in both public and private practice settings, especially if automated chart review and messaging features are utilized,” they wrote. “Our study’s resident-led framework also demonstrates the valuable role trainees and university-sponsored [quality improvement] programs play in improving patient care—a point aligned with the American College of Radiology’s Imaging 3.0 goals.”
Read more about the intervention in Academic Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.