Lack of Timely Follow-Up of Abnormal Imaging Results and Radiologists’ Recommendations

Al-Mutairi, Aymer; Meyer, Ashley N. D.; Chang, Paul; Singh, Hardeep

doi:10.1016/j.jacr.2014.09.031

Cited by 26 publications

(12 citation statements)

References 20 publications

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“…Others have hypothesized that the expression of doubt in a radiology report (for instance, describing a finding with the phrase, “cannot rule out metastatic disease,” rather than “likely benign”) would result in improved follow-up of indeterminate findings [22]. Currently, there is no standard language that is used to characterize a radiologist’s level of suspicion regarding an indeterminate finding.…”

Section: Discussionmentioning

confidence: 99%

Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence

Brothers

Kidwell

Brown

et al. 2016

Breast Cancer Res Treat

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Purpose Despite guidelines recommending against its routine use, perioperative imaging for distant metastases is frequently performed in newly diagnosed breast cancer patients, uncovering incidental findings of uncertain significance. We assessed the clinical significance of incidental findings by determining if their presence is associated with disease recurrence. Methods A retrospective review of staging imaging was performed in patients with stage II or III invasive breast cancer diagnosed 2008–2009 at a large academic medical center. Data related to perioperative imaging and disease recurrence were abstracted from the medical record. Kaplan Meier curves and Cox proportional hazards models were used to assess the association between incidental findings and time to disease recurrence. Results A total of 169 of 340 patients (49.7%) underwent staging evaluation for distant metastases (CT chest, abdomen, pelvis, bone scan, and/or PET-CT). Of these, 146 (86.4%) had at least one suspicious or indeterminate finding. Follow-up studies were performed in 73 (43.2%) patients. Nineteen patients were diagnosed with metastatic disease at diagnosis, 18 of whom had stage III disease. In patients without metastatic disease at diagnosis, 32 later developed recurrence. Non-calcified pulmonary nodules were associated with shorter time to disease recurrence (hazard ratio 2.51, 95% CI 1.13–5.57, p=0.02). Conclusions Imaging for distant metastases frequently reveals indeterminate findings, most of which are not associated with disease recurrence. The association between pulmonary nodules and recurrence warrants validation in an independent cohort. Overall, these findings support current guidelines recommending against routine extent of disease evaluation in patients with newly diagnosed stage II breast cancer.

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Section: Discussionmentioning

confidence: 99%

Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence

Brothers

Kidwell

Brown

et al. 2016

Breast Cancer Res Treat

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“…Follow-up of abnormal imaging test results remains a problem despite communication facilitated by the EHR. [3][4][5][6][7][8][9][10][11] For example, despite the presence of an "inbox" in most EHRs where providers receive electronic messages about abnormal test results, we found that patients did not receive appropriate and timely follow-up of abnormal imaging results, such as lung nodules or masses identified by a radiologist, 12,13 in nearly 8% of abnormal imaging results. 14 These "missed findings" have been associated with increased malpractice litigation and poorer patient outcomes.…”

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confidence: 99%

Computerized Triggers of Big Data to Detect Delays in Follow-up of Chest Imaging Results

Murphy

Meyer

Bhise

et al. 2016

Chest

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“…These delays in care, which typically involve well-intentioned clinicians, also occur when clinicians have good access to electronic diagnostic information. Multiple factors likely contribute to the delays, including time pressures, information overload, heavy workloads, and a lack of robust test-result tracking systems (7)(8)(9)(10)(11)(12)(13)(14)(15). Currently, identification of such delays in care requires a review of the records of all patients who undergo imaging.…”

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confidence: 99%

Development and Validation of Electronic Health Record–based Triggers to Detect Delays in Follow-up of Abnormal Lung Imaging Findings

Murphy

Thomas

Meyer³

et al. 2015

Radiology

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Hardeep Singh, MD, MPH Purpose:To develop an electronic health record (EHR)-based trigger algorithm to identify delays in follow-up of patients with imaging results that are suggestive of lung cancer and to validate this trigger on retrospective data. Materials and Methods:The local institutional review board approved the study. A "trigger" algorithm was developed to automate the detection of delays in diagnostic evaluation of chest computed tomographic (CT) images and conventional radiographs that were electronically flagged by reviewing radiologists as being "suspicious for malignancy." The trigger algorithm was developed through literature review and expert input. It included patients who were alive and 40-70 years old, and it excluded instances in which appropriate timely follow-up (defined as occurring within 30 days) was detected (eg, pulmonary visit) or when follow-up was unnecessary (eg, in patients with a terminal illness). The algorithm was iteratively applied to a retrospective test cohort in an EHR data warehouse at a large Veterans Affairs facility, and manual record reviews were used to validate each individual criterion. The final algorithm aimed at detecting an absence of timely follow-up was retrospectively applied to an independent validation cohort to determine the positive predictive value (PPV). Trigger performance, time to follow-up, reasons for lack of follow-up, and cancer outcomes were analyzed and reported by using descriptive statistics. Results:The trigger algorithm was retrospectively applied to the records of 89 168 patients seen between January 1, 2009, and December 31, 2009. Of 538 records with an imaging report that was flagged as suspicious for malignancy, 131 were identified by the trigger as being high risk for delayed diagnostic evaluation. Manual chart reviews confirmed a true absence of follow-up in 75 cases (trigger PPV of 57.3% for detecting evaluation delays), of which four received a diagnosis of primary lung cancer within the subsequent 2 years. Conclusion:EHR-based triggers can be used to identify patients with suspicious imaging findings in whom follow-up diagnostic evaluation was delayed. cancer from failure to follow up patients with abnormal imaging results remains a common problem that contributes to both malpractice litigation and poor patient outcomes (1-6). These delays in care, which typically involve well-intentioned clinicians, also occur when clinicians have good access to electronic diagnostic information. Multiple factors likely contribute to the delays, including time pressures, information overload, heavy workloads, and a lack of robust test-result tracking systems (7-15). Currently, identification of such delays in care requires a review of the records of all patients who undergo imaging. However, this nonselective review is too inefficient for practical use given the number of records that would require review and the vast amounts of information contained in electronic health records (EHRs). Likewise, sending providers information created with simple...

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Lack of Timely Follow-Up of Abnormal Imaging Results and Radiologists’ Recommendations

Cited by 26 publications

References 20 publications

Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence

Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence

Computerized Triggers of Big Data to Detect Delays in Follow-up of Chest Imaging Results

Development and Validation of Electronic Health Record–based Triggers to Detect Delays in Follow-up of Abnormal Lung Imaging Findings

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