why hospitals must do more to address incidental findings ii

Last time, our blog discussed how so-called incidental findings — unintentional yet important medical discoveries that appear in as many as one third of all imaging tests — were being grossly underreported in radiology reports or even to patients.

In particular, we discussed how this type of medical mistake was most likely to occur in emergency rooms and trauma centers, two hectic environments that see a large volume of patients and aren’t typically set up to provide follow-up care.

As disturbing as all of this is, the good news is that some of the nation’s leading medical facilities have recognized this problem and are now taking steps to help ensure that important information on incidental findings is properly relayed to patients.

  • At Massachusetts General Hospital, efforts are underway to improve tracking of incidental findings in emergency department radiology reports and, more significantly, to communicate these findings to patients as soon as possible. Similarly, nurses are also being trained to examine reports, speak with patients and follow up with primary-care physicians.
  • At the University of Chicago, a three-strikes system is being introduced whereby physicians are first reminded electronically about the need to follow up with a patient on an important incidental finding. The system is designed to send a second electronic reminder to both the physician and the department chair if there is no response or no follow-up exams ordered within a certain timeframe. Finally, the system sends a letter to both the patient and their primary-care physician if none of the requested follow-up actions are taken.
  • At Pennsylvania State University’s Milton S. Hershey Medical Center, a new program called “Failsafe” has been introduced in which radiologists must electronically flag incidental findings among ER patients, taking immediate action if they are serious, or diverting them for review by a radiology team, which will later classify them as a medium-term or long-term follow up. A letter is then mailed to the patient informing them of these findings and advising them to speak with a primary-care physician.

Here’s hoping more medical facilities follow suit and start treating incidental findings with the necessary gravity. Patients deserve this much.

Source: The Wall Street Journal, “Surprise results in medical tests draw new focus,” Laura Landro, Nov. 10, 2014

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