University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, BSH 5056, Cleveland, OH, 44106, USA.
J Digit Imaging. 2023 Jun;36(3):776-786. doi: 10.1007/s10278-022-00773-x. Epub 2023 Jan 17.
Actionable incidental findings (AIFs) are common imaging findings unrelated to the clinical indication for the imaging test for which follow-up is recommended. Increasing utilization of imaging in the emergency department (ED) in recent years has resulted in more patients with AIFs. When these findings are not properly communicated and followed up upon, there is harm to the patient's health outcome as well as possible increased financial costs for the patient, the health system, and potential litigation. Tracking these findings can be difficult, especially so in a large health system. In this report, we detail our experience implementing a closed-loop AIF program within the ED of 11 satellite hospitals of a large academic health system. Our new workflow streamlined radiologist reporting of AIFs through system macros and by using a standardized form integrated into the dictation software. Upon completion of the form, an automatic email is sent to a dedicated nurse navigator who documented the findings and closed the loop by coordinating follow-up imaging or clinic visits with patients, primary care providers, and specialists. Through the new workflow, a total of 1207 incidental finding reports have been submitted from July 2021 to May 2022. The vast majority of AIFs were identified on CT, and the most common categories included lung nodules, pancreas lesions, liver lesions, and other potentially cancerous lesions. At least 10 new cancers have been detected. We hope this report can help guide other health systems in the design of a closed-loop incidental findings program.
可操作的偶然发现（AIFs）是指与影像检查的临床指征无关的常见影像发现，建议对其进行随访。近年来，急诊科（ED）中影像检查的应用日益增多，导致出现更多的 AIFs 患者。如果这些发现没有得到妥善的沟通和随访，不仅会对患者的健康结果造成伤害，还可能导致患者、医疗体系和潜在诉讼的财务成本增加。跟踪这些发现可能很困难，尤其是在大型医疗体系中。在本报告中，我们详细介绍了在一个大型学术医疗体系的 11 家卫星医院的 ED 中实施封闭循环 AIF 计划的经验。我们的新工作流程通过系统宏和使用集成到语音识别软件中的标准化表格简化了放射科医生对 AIF 的报告。完成表格后，会自动向专门的护士导航员发送电子邮件，由其记录发现结果，并通过协调与患者、初级保健提供者和专家进行后续影像检查或就诊来完成闭环。通过新的工作流程，从 2021 年 7 月到 2022 年 5 月共提交了 1207 份偶然发现报告。绝大多数 AIFs 是在 CT 上发现的，最常见的类别包括肺结节、胰腺病变、肝脏病变和其他可能癌变的病变。至少发现了 10 例新的癌症。我们希望本报告能够为其他医疗体系设计封闭循环偶然发现计划提供指导。
