Implementing a radiology navigator program across a large health system improved follow-up imaging for patients with unexpected findings and can help keep providers out of legal trouble.
Duke University Medical Center piloted its program in October 2019, using experienced radiologic technologists to ensure incidental findings didn’t go overlooked. Navigators utilized tools within the electronic health record to order and schedule follow-up tests and communicate results.
The program worked remarkably well over a 12-month tryout, researchers reported Tuesday in Radiology. Patients and providers received results within a “reasonable” time frame (median of 12 days), and follow-up imaging was scheduled for 60% of unexpected, nonemergent findings, the authors noted.
Furthermore, a “substantial” number of findings turned out to be malignant neoplasms (11%), treatable vascular abnormalities (5%), and other problems (11%) relevant to patients’ long-term health.
The tool may even save rads and others from future problems of their own, Fides R. Schwartz, MD, and co-authors with the Durham, North Carolina, system’s radiology department explained.
“Were these findings not properly communicated and subsequently discovered in a later stage of the disease, they may have led to poor patient outcomes and possibly litigation,” the group added. “The [program] design will provide other radiology departments with a blueprint to implement closed-loop communication,” they commented later.
Duke rolled out the program across its three hospitals between October 2019-2020.
Over 12 months, navigators recorded 3,500-plus exams out of the nearly 750,000 performed across the system. The program led to 2,127 follow-up exams being performed, with more than 1,000 patients referred to primary care providers and specialists.
Nabile M. Safdar, MD, MPH, vice chair of informatics at Emory University’s Department of Radiology and Imaging Sciences, took a hard look at the study, sharing his thoughts on Aug. 10. He noted the program would require up to four well-qualified employees and potentially hundreds of thousands of dollars.
At the same time, failing to communicate results accounts for up to 23% of radiology malpractice claims, according to the ACR. And avoiding even one lawsuit could save millions, Safdar noted.
The study does leave some questions unanswered, and the additional clicks tacked on to daily workflows may dissuade some rads from participating. (A majority of rads and providers found the program useful). But Safdar praised the work.
“This foreshadows a future where the interests of patients, practices, and healthcare systems are better aligned,” Safdar concluded. “This notion may seem as burdensome to some as it is exhilarating to others due to its potential to center patient concerns and reduce medical-legal risk. Such is the nature of important, innovative work.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.