University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Br J Radiol. 2023 Feb;96(1142):20220573. doi: 10.1259/bjr.20220573. Epub 2022 Oct 1.
Increasing utilization of cross-sectional imaging has resulted in more clinically significant incidental findings being discovered. However, the current approach for handling these findings is commonly inconsistent and relies greatly on the efforts of individual clinicians. Making sure every actionable incidental finding is handled in a consistent and reliable manner can be difficult, especially for a large health system. We propose an approach to handling incidental findings aimed at improving patient follow-up rates, which involves implementing system-level processes that standardize the reporting of incidental findings, notification of clinicians and the patient, and centralized monitoring of longitudinal patient follow-up. We will lay out a general framework for standardized reporting of incidental findings by the radiologist using software integrated into the daily workflow. This should enable simultaneous notification of the ordering clinician, the patient's primary-care provider, and an incidental findings navigator. The navigator will "close the loop" by working with clinicians to notify the patient of the finding, coordinate patient follow-up, and document the finding and long-term follow-up. We hope this can serve as a basic framework to help large health systems design an incidental findings workflow to improve follow-up rates and reduce patient harm.
随着横断面成像的应用日益增多，越来越多具有临床意义的偶然发现被发现。然而，目前处理这些发现的方法通常不一致，很大程度上依赖于个别临床医生的努力。确保每一个可操作的偶然发现都以一致和可靠的方式得到处理可能很困难，尤其是对于大型医疗系统而言。我们提出了一种处理偶然发现的方法，旨在提高患者的随访率，该方法涉及实施系统级别的流程，标准化偶然发现的报告、通知临床医生和患者，以及对患者的纵向随访进行集中监测。我们将为放射科医生使用集成到日常工作流程中的软件标准化偶然发现报告制定一个通用框架。这应该能够同时通知医嘱医生、患者的初级保健提供者和偶然发现导航员。导航员将通过与临床医生合作，通知患者发现情况、协调患者随访，并记录发现和长期随访情况，从而“闭环”处理。我们希望这可以作为一个基本框架，帮助大型医疗系统设计偶然发现工作流程，以提高随访率并减少患者伤害。
