Lung cancer is the leading cause of cancer death in both men and women worldwide. Given that pulmonary nodules are a common finding on chest CT, a judicious plan for followup is necessary. A set of generally accepted, evidencebased guidelines have been published but a large proportion of these findings are not followedup in a manner congruent with the guidelines. This results in both overimaging and failure of timely followup of potentially curable malignant lesions.
The purpose of this study was to assess the impact of a standardized template of followup recommendations in radiology interpretation reports and the initiation of an electronic messaging system to the clinician requesting the imaging study on the rates of appropriate radiographic followup of indeterminate pulmonary nodules identified on computed tomography.
This retrospective study examined rates of appropriate followup, as defined by the Fleischner Society guidelines, of incidental pulmonary nodules over two seven7month periods both before (17 patients; mean age 62.7 years) and after (72 patients, mean age 61.6 years) the commencement of the quality improvement initiatives. Further analysis by risk, patient and nodule characteristics, notification type and location of imaging request were performed. Timeappropriate followup increased from 35.3% (6/17) to 56.9% (49/72) [P = 0.18]. The largest change was noted in highrisk patients with an improvement from 11.1% (1/9) appropriate followup to 51.4% (18/35) [P = 0.06] following the interventions. The biggest improvement in ontime followup imaging was a reduction in premature imaging, which decreased from 17.6% (3/17) to 6.9% (5/72) [P = 0.18]. Regarding patient and nodule characteristics, the most prominent improvements in appropriate scanning interval was noted in patients aged 3549 (0% to 50.0%; P = 0.11) and in those with nodules size >46mm (0% to 50.0%; P = 0.12).
The appropriateness of followup imaging improved following the implementation of the quality improvement initiatives although this did not reach statistical significance. The largest improvement appeared to be for highrisk patients.
To cite this abstract:Sykes A, Knudsen J, Elias R, Morgenthaler T. Impact of a Standardized Recommendation and Electronic Prompts on Followup of Indeterminate Pulmonary Nodules Found on Computed Tomography. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97721. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-a-standardized-recommendation-and-electronic-prompts-on-followup-of-indeterminate-pulmonary-nodules-found-on-computed-tomography/. Accessed April 5, 2020.