Simple notification system for overdue radiology recommendations bolsters follow-up rates

A notification system for overdue imaging recommendations bolsters follow-up rates and produces clinically significant diagnoses, according to new research published in the American Journal of Roentgenology.

Accurately detecting abnormal findings is the radiologists’ main job, but relaying results is also key to timely care. And communication errors can cause delays and ultimately lead to malpractice claims, researchers explained Wednesday.

Using med students and residents to send reminders for overdue follow-up and ensure radiologists’ recommendations are completed, meanwhile, decreased incompletions from 26% to 20%. A handful of those lost in the shuffle also proved to have important findings, such as nodules requiring biopsy and malignant masses

“The present study shows that a dedicated system for communication of overdue radiology recommendations increases rates of completion of follow-up recommendations and has the potential to yield a substantial number of additional workups and clinically important diagnoses per year,” Jaimee Mannix, MD, of Washington University School of Medicine in St. Louis’ Mallinckrodt Institute of Radiology, and colleagues wrote.

For their study, Mannix and co-authors searched imaging reports at a single institution for the words “recommend” or “advised,” yielding 9,784 studies. After excluding those requiring immediate action, “soft recommendations,” and 503 patients who completed follow-up, the group was left with 177 individuals overdue for exams.

Of that group, 36 finished their follow-up after a reminder, 34 had their recommendations deemed “nonindicated,” and 107 were lost to follow-up. The strategy uncovered four important diagnoses: a malignancy, one growing mass, and two thyroid nodules that needed a biopsy.

Diving deeper into the data, Mannix et al. found a whopping 83% of all unresolved cases were caused by either missed appointments, patients not scheduling their follow-ups, or providers ignoring radiologists’ recommendations.

“We believe that targeting these three areas with a dedicated scheduling navigator and additional rounds of provider notification than was attempted in this study could further reduce the number of incomplete follow-ups and would merit additional study,” the authors concluded.

You can read the entire study here.

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