Point-of-Care Reference Materials Increase Practice Compliance With Societal Guidelines for Incidental Findings in Emergency Imaging

Abstract

Purpose: The aim of this study was to assess the efficacy of an educational framework encouraging the systematic application of national societal recommendations regarding the imaging evaluation and follow-up of incidental findings (IFs) in the emergency department.

Methods: After institutional review board approval was received, consecutive CT and ultrasonographic examinations from the emergency department over a 2-month period were collected. Examination reports were categorized by study type and evaluated individually for the presence of IFs that fit into the following core categories: solid or subsolid pulmonary nodules, liver lesions, splenic lesions, gallbladder polyps, pancreatic cystic lesions, adrenal nodules, adnexal cysts on CT or ultrasonography, thyroid nodules (CT), and abnormal lymph nodes. Subsequently, after an educational intervention consisting of printed and electronic references, e-mail, and verbal communication detailing societal guidelines and the introduction of voice recognition macros, data were recollected in the same fashion for an additional 2-month period.

Results: A total of 3,131 imaging events occurred in the 2-month preintervention period, yielding 514 total incidental findings. Of these 514 findings, 67.5% were correctly managed and 32.5% were incorrectly managed according to societal recommendations. In the postintervention period, 3,793 imaging events yielded 499 total incidental findings. Of these 499 findings, 80.2% were correctly managed and 19.8% were incorrectly managed. The increased rate of reporting incidental findings in concordance with societal guidelines was statistically significant (P < .0001).

Conclusions: Point-of-care decision support reference materials increase radiologist compliance with societal guidelines for incidental findings. Compliance with societal guidelines improves patient care and has cost-saving implications.

Keywords: American College of Radiology; Incidental findings; clinical decision support system; emergency; radiology.