Automated Notification for Followup Testing Recommendations Across Care Settings

The role of radiological imaging is integral to diagnosing diseases. Imaging results are read by radiologists, who contact the referring clinician whenever a critical result is deemed significant. Failure to communicate abnormal imaging test results and delay in followup can lead to additional patient interventions and complications. The project team previously developed the Alert Notification of Critical Test Results (ANCR) system, which enabled notification of referring providers when results were critical or unexpected. Although ANCR increased documented communication of critical results between caregivers, critical result followup was inadequate, especially when the recommendations were less urgent.

While critical results may be identified in emergency or inpatient settings, followup is primarily the responsibility of ambulatory care providers. Identifying and communicating about critical results at times of patient transitions in care between non-ambulatory and ambulatory settings is therefore crucial. This subsequent project expanded the ANCR intervention to facilitate notification of primary care providers (PCPs) of recommended followup testing to improve patient safety. It also evaluated the impact of a discharge module at an academic medical center that captures followup recommendations for further management of patients with pulmonary nodules and renal masses.

The specific aims of the project were as follows:

• Use a computerized system to communicate the radiologist’s followup recommendations to the ambulatory PCP and enable the followup recommendations to be included in the discharge plan. 
• Evaluate the impact of the system on timely implementation of recommended followup procedures. 

Researchers used a randomly selected sample of radiology reports from July 2009 to June 2014 to evaluate documented communication of critical imaging findings through ANCR. Web-based inpatient and emergency department discharge modules were implemented, and enabled inclusion of imaging results for chest or abdominal CT exams, recommendations for followup management, and radiology reports designed to provide access for ambulatory providers. Implementation of the modules was associated with significantly improved followup of patients with pulmonary nodules within 1 year after discharge. No significant effect on renal mass followup was identified. However, analysis revealed that the presence of an explicit radiologist recommendation was a significant predictor for completion of recommended additional testing. Future studies should focus on the impact of more intensive interventions, in addition to health information technology implementation, to further improve followup of critical findings.