Please help us by sharing your solutions to reduce diagnostic errors!

Michael H. Kanter Michael.H.Kanter at KP.ORG
Wed Jul 5 14:19:12 UTC 2017

We have developed some programs to track incidental findings found in radiology reports.
The basic system requires the radiologist to flag certain incidental findings in an electronic tool called the significant findings tool.  They do this for lung nodules and aortic aneurysms.  We then wait an appropriate time period that gives the clinician and patient time to follow up on the findings.  If they do not, a nurse/LVN initiatiates follow up.
For lung nodules we follow Fleishner criteria but wait a bit longer to look for follow up.  We determine follow up by looking for subsequent radiologic studies or appointments to our pulmonary department.  For AAA we also have follow up criteria that depends on the size of the AAA and based on the size we look for either a follow up abdominal US or an appointment to vascular surgery.  If these are not done by a certain time.,the RN/LVN arranges these.
For lung nodules, we only track new ones.  We keep track of the number of follow ups we do and the number of cancers found.
For AAA , we track both incidental findings that the clinician knows about (based on him/her putting in ICD10 codes for AAA) as well as those AAA that the clinician may not know about (as evidenced by there being no diagnosis code in the medical record or problem list).   We have found many hundreds to thousands of AAA not followed up.  We also identify even more cases of aortic ectasia that is not recognized.

We have published a bit on these but have not specifically written a paper describing each one separately.  The AAA paper describes our screening program but also contains a description of the tracking program we have that will pick up incidental findings.   .

From: Diana Rusz [mailto:Diana.Rusz at IMPROVEDIAGNOSIS.ORG]
Sent: Friday, June 30, 2017 6:32 AM
Subject: [IMPROVEDX] Please help us by sharing your solutions to reduce diagnostic errors!

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The Practice Improvement Committee of the Society to Improve Diagnosis in Medicine (SIDM) has been working to identify and prioritize evidence-based and promising solutions to share.  We are particularly looking now for unpublished solutions that you have implemented, preferably with some data to support their effectiveness in two areas: 1) The Referral Process and 2) Incidental Radiographic Findings

1)      Referral Process:  If you have implemented improvements to the referral process, in particular, a tracking system for patients referred to specialty providers or standardized referral templates and policies describing roles and responsibilities for providers referring patients and receiving referrals, please send us an email describing your solution and the impact you have measured.

2)      Incidental Radiographic Findings: We are looking for efforts that address the communication and follow-up of INCIDENTIAL FINDINGS that are noted in RADIOLOGY studies. While lung nodules are likely the most common, we are interested in system and process solutions that address any incidental (not related to the intended reason for the study) finding in radiology studies / reports. E.g. Who notes them....who "owns" them..... what is the process for communicating to the ordering provider or the patient... how do we ensure that there is an action plan and follow-up?

If you have an initiative to share or other information related to these topics please contact the committee chairs as noted below.

Doug Salvador MD MPH - doug.salvadorMD at<mailto:doug.salvadorMD at>
Chair- Referrals Subcommittee of the SIDM Practice Improvement Committee

Dana Siegel  - DSiegal at<mailto:DSiegal at>
Chair - Incidental Findings Subcommittee of the SDM Practice Improvement Committee

Thank you for contributing to the effort to bring forward effective solutions.



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