With the rising trend of imaging quality as well as use, several secondary or incidental findings follow. However, new studies suggest that patients must adhere to recommended follow-up examinations for incidental discoveries are largely dependent on the type of provider and care settings.
Doctors at the University of California discovered this at the Davis Medical Center, after analyzing the reports of more than hundreds of CT radiology completed over six months. Overall compliance besides further imaging recommendations reported averages, with outpatient sites and primary healthcare providers the most likely to conduct such exams.
Shan S. Hansra, MD, an eminent personality with an institution at Sacramento, California, wrote in JACR referring physicians as very responsible for handling the rad report recommendations. However, when incidental lesions or nodules evolve in the report, consequences are obvious.
Hansra along with colleagues explained, “Recommendations for additional imaging or RAIs are not followed always, which can lead to delays in diagnosis and treatment, as well as poor patient outcomes and legal liability. To improve adherence to RAIs, it is important to understand the factors that affect adherence rates.”
Researchers did exactly that. They looked into 539 reports retrospectively, suggesting more imaging for the incidental findings in CT results and confirmed if the exams were finalized after analyzing the charts of patients.
In 39.1% of the cases, radiologist recommendations have been followed, which rose to 56.8% in patients with primary care providers at the same medical institution. In addition, 3.5% chest imaging, 3.1% pelvis and abdomen, and 3.1% neck imaging had the highest rate of RAI. Contrariwise, spine, head, face, and extremity has the lowest rate at 0.8%, 0.3%, and 0.1%.
When it comes to adherence, location is the key factor. Outpatient diagnostic exams led settings, with the emergency and inpatient department rounding out the specific groups.
Ordering specialty providers was significant too, with PCPs abiding in at least 67% of the cases, trailed by 50% of subspecialists, and 37.7% of surgeons.
The key factor for incomplete follow-up, however, is communication lapse, according to the authors. Documented instances in patients’ discharge summaries boost adherence, but such diagnosis reports omit details. Many patients only receive the result of tests after they are released.
To fight these issues, the research team led by Hansra argued that rads should be standardized documentation as well as communication of the findings needing further analysis.
The research concluded, “Our data suggest that systematic actions such as these are even more crucial for emergency patients and inpatients as well as for examinations ordered by surgeons. We are currently exploring different techniques of having interpreting radiologists prospectively flag reports that require imaging follow-up at our institution.”
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