Background

Reliance on examination reporting of unexpected imaging findings does not ensure receipt of findings or appropriate follow-up. A closed-loop communication system should include provider and patient notifications and be auditable through the electronic health record (EHR).

Purpose

To report the initial design of and results from using an EHR-integrated unexpected findings navigator (UFN) program that ensures closed-loop communication of unexpected nonemergent findings.

Materials and Methods

An EHR-integrated UFN program was designed to enable identification and communication of unexpected findings and aid in next steps in findings management. Three navigators (with prior training as radiologic technologists and sonographers) facilitated communication and documentation of results to providers and patients. Twelve months (October 2019 to October 2020) of results were retrospectively reviewed to evaluate patient demographics and program metrics. Descriptive statistics and correlation analysis were performed by using commercially available software.

Results

A total of 3542 examinations were reported within 12 months, representing 0.5% of all examinations performed (total of 749 649); the median patient age was 62 years (range, 1 day to 98 years; interquartile range, 23 years). Most patients were female (2029 of 3542 [57%]). Almost half of the examinations submitted were from chest radiography and CT (1618 of 3542 [46%]), followed by MRI and CT of the abdomen and pelvis (1123 of 3542 [32%]). The most common unexpected findings were potential neoplasms (391 of 3542 [11%]). The median time between examination performance and patient notification was 12 days (range, 0–136 days; interquartile range, 13 days). A total of 2127 additional imaging studies were performed, and 1078 patients were referred to primary care providers and specialists. Most radiologists (89%, 63 of 71 respondents) and providers (65%, 28 of 43 respondents) found the system useful and used it most frequently during regular business hours.

Conclusion

An electronic health record–integrated, navigator-facilitated, closed-loop communication program for unexpected radiologic findings led to near-complete success in notification of providers and patients and facilitated the next steps in findings management.

© RSNA, 2021

See also the editorial by Safdar in this issue.

中文翻译：

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针对意外非紧急发现的电子健康记录闭环通信程序

背景

依赖意外影像检查结果的检查报告并不能确保收到检查结果或适当的随访。闭环通信系统应包括提供者和患者的通知，并可通过电子健康记录 (EHR) 进行审核。

目的

报告使用 EHR 集成的意外发现导航器 (UFN) 程序的初始设计和结果，该程序可确保意外非紧急发现的闭环通信。

材料和方法

与 EHR 集成的 UFN 计划旨在识别和传达意外发现，并帮助发现管理的后续步骤。三名导航员（接受过放射技师和超声技师的事先培训）促进了与提供者和患者的交流和结果记录。回顾性审查了 12 个月（2019 年 10 月至 2020 年 10 月）的结果，以评估患者人口统计数据和项目指标。使用市售软件进行描述性统计和相关分析。

结果

12 个月内共报告了 3542 次检查，占所有检查的 0.5%（共计 749649 次）；患者的中位年龄为 62 岁（范围，1 天至 98 岁；四分位距，23 岁）。大多数患者为女性（3542 名中的 2029 名 [57%]）。提交的检查中几乎有一半来自胸部 X 光片和 CT（3542 个中的 1618 个 [46%]），其次是腹部和骨盆的 MRI 和 CT（3542 个中的 1123 个 [32%]）。最常见的意外发现是潜在的肿瘤（3542 个中的 391 个 [11%]）。检查执行和患者通知之间的中位时间为 12 天（范围，0-136 天；四分位距，13 天）。总共进行了 2127 项额外的影像学研究，并将 1078 名患者转诊到初级保健提供者和专家处。大多数放射科医生（89%，71 名受访者中的 63 名）和提供者（65%，

结论

针对意外放射学发现的电子健康记录集成、导航器辅助、闭环通信程序导致在通知提供者和患者方面几乎完全成功，并促进了发现管理的后续步骤。

©北美放射学会，2021

另请参阅本期 Safdar 的社论。