Hammer Mark M, Kapoor Neena, Desai Sonali P, Sivashanker Karthik S, Lacson Ronilda, Demers John P, Khorasani Ramin
Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.
Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
AJR Am J Roentgenol. 2019 May;212(5):1077-1081. doi: 10.2214/AJR.18.20692. Epub 2019 Feb 19.
The purpose of this study is to assess radiologists' adoption of a closed-loop communication and tracking system, Result Alert and Development of Automated Resolution (RADAR), for incidental pulmonary nodules and to measure its effect on the completeness of radiologists' follow-up recommendations. This retrospective study was performed at a tertiary academic center that performs more than 600,000 radiology examinations annually. Before RADAR, the institution's standard of care was for radiologists to generate alerts for newly discovered incidental pulmonary nodules using a previously described PACS-embedded software tool. RADAR is a new closed-loop communication tool embedded in the PACS and enterprise provider workflow that enables establishing a collaborative follow-up plan between a radiologist and referring provider and helps automate collaborative follow-up plan tracking and execution. We assessed RADAR adoption for incidental pulmonary nodules, the primary outcome, in our thoracic radiology division (study period March 9, 2018, through August 2, 2018). The secondary outcome was the completeness of follow-up recommendation for incidental pulmonary nodules, defined as explicit imaging modality and time frame for follow-up. After implementation, 106 of 183 (58%) incidental pulmonary nodules alerts were generated using RADAR. RADAR adoption increased by 75% during the study period (40% in the first 3 weeks vs 70% in the last 3 weeks; < 0.001 test for trend). All RADAR alerts had explicit documentation of imaging modality and follow-up time frame, compared with 71% for non-RADAR alerts for incidental pulmonary nodules ( < 0.001). A closed-loop communication system that enables establishing and executing a collaborative follow-up plan for incidental pulmonary nodules can be adopted and improves the quality of radiologists' follow-up recommendations.
本研究的目的是评估放射科医生对用于偶然发现的肺结节的闭环通信与追踪系统（结果警报与自动解决系统开发，RADAR）的采用情况，并衡量其对放射科医生后续建议完整性的影响。这项回顾性研究在一家每年进行超过60万次放射学检查的三级学术中心开展。在RADAR系统应用之前，该机构的医疗标准是放射科医生使用先前描述的PACS嵌入式软件工具，对新发现的偶然肺结节发出警报。RADAR是一种嵌入PACS和企业医疗服务工作流程的新型闭环通信工具，它能够在放射科医生和转诊医生之间建立协作性的后续跟进计划，并有助于自动跟踪和执行协作性后续跟进计划。我们评估了在我们的胸部放射科（研究期为2018年3月9日至2018年8月2日）中，RADAR在偶然肺结节方面的采用情况，这是主要结果。次要结果是偶然肺结节后续建议的完整性，定义为明确的随访成像方式和时间框架。实施后，183个偶然肺结节警报中有106个（58%）是使用RADAR生成的。在研究期间，RADAR的采用率提高了75%（前三周为40%，后三周为70%；趋势检验P<0.001）。所有RADAR警报都有关于成像方式和随访时间框架的明确记录，相比之下，偶然肺结节的非RADAR警报这一比例为71%（P<0.001）。一种能够为偶然肺结节建立并执行协作性后续跟进计划的闭环通信系统是可以被采用的，并且能够提高放射科医生后续建议的质量。
