Communication of Incidental Imaging Findings on Inpatient Discharge Summaries After Implementation of Electronic Health Record Notification System

Govind Mattay; Kushanth Mallikarjun; Paula Grow; Aaron Mintz; Thomas Ciesielski; Anthony Dao; Shivani Mattay; Geoffrey Cislo; Raghav Mattay; Vamsi Narra; Andrew Bierhals

doi:10.1097/PTS.0000000000001221

Communication of Incidental Imaging Findings on Inpatient Discharge Summaries After Implementation of Electronic Health Record Notification System

J Patient Saf. 2024 Mar 18. doi: 10.1097/PTS.0000000000001221. Online ahead of print.

Authors

Affiliations

¹ From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
² Mount Carmel Transitional Year, Grove City, Ohio.
³ Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri.
⁴ Department of Radiology and Biomedical Imaging, University of California San Francisco, California.

PMID: 38506482
DOI: 10.1097/PTS.0000000000001221

Abstract

Objectives: Inadequate follow-up of incidental imaging findings (IIFs) can result in poor patient outcomes, patient dissatisfaction, and provider malpractice. At our institution, radiologists flag IIFs during report dictation to trigger electronic health record (EHR) notifications to providers and patients. Nurse coordinators directly contact patients or their primary care physicians (PCPs) regarding IIFs if follow-up is not completed within the recommended time frame. Despite these interventions, many patients and their PCPs remain unaware of IIFs. In an effort to improve awareness of IIFs, we aim to investigate communication of IIFs on inpatient discharge summaries after implementation of our EHR notification system.

Methods: Inpatient records with IIFs from 2018 to 2021 were retrospectively reviewed to determine type of IIFs, follow-up recommendations, and mention of IIFs on discharge summaries. Nurse coordinators spoke to patients and providers to determine their awareness of IIFs.

Results: Incidental imaging findings were reported in 51% of discharge summaries (711/1383). When nurse coordinators called patients and PCPs regarding IIFs at the time follow-up was due, the patients and PCPs were aware of 79% of IIFs (1096/1383).

Conclusions: With implementation of EHR notifications to providers regarding IIFs, IIFs were included in 51% of discharge summaries. Lack of inclusion of IIFs on discharge summaries could be related to transitions of care within hospitalization, provider alert fatigue, and many diagnostic testing results to distill. These findings demonstrate the need to improve communication of IIFs, possibly via automating mention of IIFs on discharge summaries, and the need for care coordinators to follow up on IIFs.