Incidental Findings on the National Radar

How hospitals and emergency departments deal with incidental findings was the subject of a recent article in the Wall Street Journal, in which three programs were identified that ensure referring physicians, PCPs and patients are made aware of the incidentaloma.

• Massachusetts General Hospital has established a pilot clinic where radiologists can meet directly with patients who are scanned regularly to monitor the progression of diseases of the liver, lungs and heart to discuss the implications of incidental findings. Last year, an MGH emergency physician was lead author on a study that revealed 4.5% of ED radiology reports included follow-up recommendations for incidental findings but just half were noted in patient discharge instructions.

• The University of Chicago Hospitals has developed a three-strikes system that electronically prompts referring physicians to follow up on incidental findings deemed significant. On the second reminder, the physician’s chairman is copied. If that produced no results, then a letter alerts the patient and their primary care physician to the finding.

• The Milton S. Hershey Medical Center has implemented a program it calls Failsafe and requires radiologists to flag ED studies with incidental findings not related to the ED visit. A radiology team reviews non-urgent findings to assess whether the patient requires medium- or long-term follow-up, and those patients receive a letter urging them to contact their primary care physician for follow up.