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Emergency, Radiology Groups Suggest Best Practices for Incidental Findings

By Jonathan Springston, Editor, Relias Media

The American College of Emergency Physicians (ACEP) and the American College of Radiology (ACR) have published a white paper that includes recommendations for handling actionable incidental findings (AIF), lesions or masses that appear on ordered patient images, often in emergency settings.

Many test images ordered in the emergency department (ED) return with something the provider was not looking for at the initial patient visit. If these findings are not relevant to the reason for the patient’s initial visit or of little consequence, some of those findings could be overlooked or simply ignored. But what happens when there is a serious AIF that needs attention, but the patient has been sent home?

“Unlike other specialties, emergency physicians focus on addressing a patient’s possible life-threatening conditions and are less directly involved in follow-up care,” said Susan E. Sedory, MA, CAE, executive director and CEO of ACEP. “Partnerships at the national and local level can enhance information-sharing to help ensure all patients receive the ongoing, quality care they need.”

The ACEP and ACR recommendations are built around four areas: reporting, communication with patients, communication with clinicians, and follow-up and tracking systems.

“Strong communication and collaboration between clinicians when addressing actionable incidental findings is key to providing optimal patient care and preventing adverse outcomes,” said William T. Thorwarth, Jr., MD, FACR, CEO of ACR. “The recommendations created by ACR and ACEP highlight a multispecialty effort between radiology and emergency medicine that aim to improve the reporting and communication of AIFs, which will ultimately benefit the patient.”

Some health systems are addressing AIFs in their own way. For example, in the ED at Vanderbilt University Medical Center, staff built a plan around ensuring patient contact information was thorough and current. Also, staff made concerted efforts to contact patients with AIF, even sending certified letters if patients were unreachable by phone.

As reported in the September 2022 issue of ED Management (EDM), Vanderbilt’s process includes ED nurse case managers, ED social workers, and Vanderbilt Cancer Center nurse navigators. An electronic notification about an incidental finding is sent to either the ED nurse case manager or nurse navigator, who contact the patient (typically by phone) within a few days of the visit to coordinate a follow-up plan. The notification also triggers a standard text reminder about the incidental finding in the patient’s after-visit summary.

“Ensuring that patients are notified of findings that may represent an early cancer is critically important,” Tyler W. Barrett, MD, MSCI, executive medical director of emergency services at Vanderbilt University Medical Center, told EDM. “This program’s success is the result of outstanding interdepartmental collaboration among our emergency medicine, radiology, informatics, cancer center, case management, and social worker teams.”

For more on this and related subjects, be sure to read the latest issues of ED Management and Medical Ethics Advisor.