Standardized workflow between emergency, rad depts improves incidental findings

Incidental findings can lead to negative consequences for patients, but establishing a standardized method of communicating these discoveries between emergency and radiology departments can improve patient safety.

A study, led by Steven J. Baccei, MD, associate professor at the University of Massachusetts Medical School in Worcester, published online Jan. 3 in The Journal of the American College of Radiology points out that “although many incidental findings do not have an immediate life-threatening impact on patients’ health, some carry significant implications for future morbidity and mortality.”

Baccei and colleagues wrote, while the Commonwealth of Massachusetts Board of Registration in Medicine released a 2016 advisory expressing a need for improved communication of incidental findings on radiology studies from the ED and inpatient settings, progress in the field has been slow.

“There are few examples of health care facilities designing ways to manage incidental findings,” Baccei wrote.

The group organized a multidisciplinary team which was led by multiple staff in the UMass health system, including the vice chair of quality and patient safety in radiology. They set out to address the underlying problems of the incidental findings communication and subsequently designed new workflows and operation pathways for radiology and ED staff to communicate findings.

Among the findings for failed incidental findings communication were:

• ED physician not receiving the radiology report before patient discharge.
• Incidental findings falling through the cracks because of more urgent or critical findings.
• Patient not being informed that she needed follow-up.
• Radiologist not seeking acknowledgement from the ED provider(s) about the finding.
• Patient’s primary care doctor not being notified.
• Patient simply not going for the follow-up imaging (or other recommendation).

Among the 1,409 incidental findings documented during the study, the greatest number were found on CT exams (1,204), followed by radiography (162) and ultrasound (38).

New workflows and a standardized communication system were established between the ED and radiologists. That included a loop-closure measure which resulted in a 93 percent compliance rate for incidental finding communication.

Importantly, the authors note because there was no standard method of reporting incidence findings prior to the newly created workflow, they were unable to collect any baseline data for the study.

“In general, each ED is a unique environment or system, so although our workflows may not be generalizable to every ED, they serve as a template for leadership to develop a pathway for the management of incidental findings,” Baccei and colleagues wrote.