November 12, 2014

How hospitals make sure 'incidental findings' don't fall through the cracks

Daily Briefing

A third of imaging tests reveal "incidental findings" that were not related to the purpose of the test, but doctors often don't investigate further, the Wall Street Journal's Laura Landro reports. 

Sayon Dutta, an ED physician at Massachusetts General Hospital, emphasizes the importance of acting on incidental findings, or abnormalities uncovered unintentionally and unrelated to the condition that prompted a test. "You had the luck of finding this thing early because you had a CT scan for another reason, and you should take advantage of that early detection to get the best care possible," he says.

But last year, a study in the Annals of Emergency Medicine found that only half of ED radiology reports that had notes on incidental findings were followed up on.

In an effort to ensure that incidental findings receive proper follow-up care, Mass General is working to better track incidental findings from ED tests, improve communication between patients and radiologists, and have nurses evaluate findings and ensure they are followed up on after discharge.

In addition, Mass General is launching a pilot clinic where frequently imaged patients—such as those with heart conditions—review images and notes directly with a radiologist. Mark Mangano, a radiologist who is involved with the clinics, says, "These findings often provide key information about a patient's health which can be used to make positive changes."

Generally, experts say that patients should be sure to talk over test results with their doctor and heed recommendations for further imaging—advice that about 82% of patients do not follow, according to data from Mass General.

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However, some experts caution that being too aggressive in following up on incidental findings can create additional medical problems for patients--such as with the elderly. Phillip Young, chair of the Division of Body MRI at Mayo Clinic, cautions, "we want to handle these incidental findings as judiciously as possible and do all of the good and none of the harm."

Generally, many hospitals view incidental findings as an important area where quality can be improved.

The University of Chicago is developing an automated "three strikes" system to remind doctors to follow up on incidental findings. Initially, an email is sent to the doctor, then a reminder is sent copying the head of the department, and finally a letter is sent to the patient and his or her primary care doctor if no follow up actions are ordered.

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Pennsylvania State University’s Milton S. Hershey Medical Center is developing a similar system. Michael Bruno, a professor of radiology at Penn State who helped develop the system, says, "The patients themselves may have a false sense of security since they have seen a doctor and undergone what seemed to them to be a thorough evaluation" (Landro, Wall Street Journal, 11/10).

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