Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York.
Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York.
J Am Coll Radiol. 2023 Aug;20(8):796-803. doi: 10.1016/j.jacr.2023.04.020. Epub 2023 Jul 7.
Incidental radiologic findings are commonplace, but the episodic nature of emergency department (ED) care makes it challenging to ensure that patients obtain appropriate follow-up. Rates of follow-up range from 30% to 77%, with some studies demonstrating that more than 30% have no follow-up at all. The aim of this study is to describe and analyze the outcomes of a collaborative emergency medicine and radiology initiative to establish a formal workflow for the follow-up of pulmonary nodules identified during ED care.
A retrospective analysis was performed of patients referred to the pulmonary nodule program (PNP). Patients were divided into two categories: those with follow-up and those who do not have post-ED follow-up. The primary outcome was determining follow-up rates and outcomes, including patients referred for biopsy. The characteristics of patients who completed follow-up compared with those lost to follow-up were also examined.
A total of 574 patients were referred to the PNP. Initial follow-up was established in 390 (69.1%); 30.8% were considered lost to follow-up, and more than half of these patients did not respond to initial contact. There were minimal differences in characteristics between patients in these two categories. Of the 259 patients who completed PNP follow-up, 26 were referred for biopsy (13%).
The PNP provided effective transitions of care and potentially improved patient health care. Strategies to further enhance follow-up adherence will provide iterative improvement of the program. The PNP provides an implementation framework for post-ED pulmonary nodule follow-up in other health care systems and can be modified for use with other incidental diagnostic findings.
偶然发现的放射学结果很常见，但由于急诊科（ED）护理的间歇性，确保患者获得适当的随访变得具有挑战性。随访率范围为 30%至 77%，一些研究表明，超过 30%的患者根本没有随访。本研究旨在描述和分析一项急诊医学和放射学合作倡议的结果，该倡议旨在为 ED 护理期间发现的肺结节建立正式的随访工作流程。
对转诊至肺结节计划（PNP）的患者进行回顾性分析。患者分为两类：有随访和没有 ED 后随访的患者。主要结果是确定随访率和结果，包括转诊进行活检的患者。还检查了完成随访的患者与失访患者的特征差异。
共有 574 名患者被转诊至 PNP。390 名（69.1%）建立了初始随访；30.8%被认为失访，其中一半以上的患者未回复初始联系。这两个类别患者的特征几乎没有差异。在完成 PNP 随访的 259 名患者中，有 26 名被转诊进行活检（13%）。
PNP 提供了有效的护理过渡，并可能改善了患者的医疗保健。进一步加强随访依从性的策略将为该计划提供迭代改进。PNP 为其他医疗保健系统的 ED 后肺结节随访提供了实施框架，并可修改用于其他偶然诊断结果。
