Central PA Medicine Fall 2017 - 34

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Practice Management

Project
Failsafe:
An Innovative Approach
to Managing Incidental
Findings on Radiology
Reports of ED Patients
By SHYAM SABAT, M.D.

magine a common scenario where a patient in a car crash
comes to the ED with back pain. CT of the spine shows a
T12 compression fracture that can be conservatively managed.
But the radiologist also sees a 1 cm spiculated lung nodule.
The nodule is mentioned in the radiologists' report, which is
transmited to the ED physician; the patient is admitted to the
orthopedic service in the hospital and is treated for the fracture,
but the reported nodule is overlooked by everyone during the
acute admission and is not mentioned in the discharge summary.
Fast-forward 1 year: the fracture has healed, the back pain has
long disappeared, but the patient develops new hemoptysis. A
chest CT shows the nodule has now grown into an unresectable
lung cancer, with local nodal and distant metastases.
The scenarios for such occurrences are numerous - a small brain
tumor seen during a CT for facial fracture, a questionable renal
mass seen during lumbar spine CT for trauma, a humeral head
lytic lesion noted during a routine a chest xray. The list can go on.
Enter 'Failsafe'
Cases such as these at Penn State Hershey medical center caused
great concern to our Radiology Quality & Safety committee
members. In review of the relevant literature, a Mass General
study by Dutta et al, showed that although 4.5 % of ED radiology
reports included recommendations to follow up on incidental
findings, only half were included in the patient's discharge summaries. Another study noted that only 18% of patients actually
follow up with imaging recommendations made at discharge.
Our safety/quality committee initially considered the possibility
of addressing this problem by sending ED patients' radiology
reports directly to their PCPs as well as to the ED physician.
But most ED patients queried either did not know their PCP's
name or did not have one.

34 Fall 2017 Central PA Medicine

Table of Contents for the Digital Edition of Central PA Medicine Fall 2017