Automated follow-up ensures response to abnormal findings

A patient comes into a facility for a diagnostic imaging exam, the interpreting physician reads the study and notes abnormal findings in the report, staff contacts the referring clinician directly with the results, and then waits for the referrer to follow-up. The vast majority of the time these recommendations are acted upon and the appropriate imaging procedures are ordered.

However, some of these requests for follow-up due to abnormal results fall through the cracks—in spite of direct telephone communication with the referring physician. A team at the Veterans Affairs Hospital in Baltimore has created an automated application to ensure that none of its follow-up requests are overlooked.

According to Amy Musk, MD, who presented an overview of the software at the recent 2007 Radiological Society of North America annual meeting, their automated tracking system allows the facility to provide not only an audit of communication and receipt of abnormal findings, but also offers feedback on follow-up, closing a potential loophole in patient management.

“The purpose of our study was to retrospectively analyze follow-up actions by referring clinicians who received abnormal imaging reports by direct telephone communication with the radiology service,” she said. “Our goal was to determine the rate of abnormal findings that were not followed up and to identify reasons for lack of follow-through.”

The group analyzed the work of staff radiologists over 15 months at the Veterans Affairs hospital. A total of 1,650 abnormal imaging reports, out of 56,083 total reports, were telephoned to referring practitioners with recommendations for follow-up procedures over the 15-month study period.

“At our institution all significant positive findings are communicated directly to the referring physician by the radiology administrators, who communicate with the referring physicians on monthly bases to assess and document compliance with the follow-up recommendation,” Musk said.

She reported that patients with no evidence of imaging follow-up in response to repeated communication of abnormal findings were identified, and evaluated for the purpose of the study. Patients who had follow-up imaging or further work-up at an outside institution were documented as follow-up complete for the purpose of the study, according to Musk.

Of the 1,650 abnormal reports, 153 had no evidence of imaging follow-up even after multiple communication encounters with the referring physician. The largest group of patients was originally seen in the emergency department, followed by managed care, surgical service, the medical clinical center, research programs, and neurology.

“Direct communication of abnormal findings and follow-up recommendations does not necessarily ensure that clinicians will follow through with additional imaging studies on their patients,” Musk noted.

The automated system ensures that the referring clinicians of patients with abnormal findings are contacted until their response to the report can be documented. Musk observed that this tool provides the facility with the capability to ensure that its patients are being managed by their referrers.

“Although in some cases this [lack of response to abnormal findings] may be as a result of additional information available to the practitioners, our results underscore the potential value of a manual or automated tracking system for radiologic follow-up of such recommendations,” she said.