Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with...

Area of Science:

• Radiology
• Health Informatics
• Patient Safety

Background:

• Incidental findings on emergency department (ED) imaging studies often require outpatient follow-up.
• Effective systems are needed to connect patients with these findings to appropriate surveillance.
• Failure to follow up on incidental findings can lead to missed diagnoses and adverse outcomes.

Purpose of the Study:

• To report the design and implementation of an electronic health record-based interdisciplinary referral system.
• To evaluate the system's effectiveness in connecting emergency department patients with incidental radiology findings to outpatient surveillance over 13 months.

Main Methods:

• Standardized critical radiology alerts and a follow-up request form were implemented within the electronic health record.
• Nurse case managers arranged patient follow-ups based on findings and clinical significance.
• The primary outcome measured was the proportion of patients with documented communication and a follow-up plan.

Main Results:

• Over 13 months, 932 emergency department visits involved critical radiology alerts, with 982 incidental findings.
• The system achieved documented communication and a follow-up plan in 95.3% of cases (888 out of 932 visits).
• Follow-up was not confirmed for 4.7% of patients.

Conclusions:

• A standardized notification and referral system for emergency department patients with incidental radiology findings was successfully implemented.
• This system represents an important patient safety intervention, particularly for identifying potential undiagnosed malignancies.
• Reliable systems for managing incidental findings are crucial for improving patient care and outcomes.