Abnormal Imaging Results Lost to Follow-up

Tracking systems should be developed to ensure timely follow-up recommendations that result from abnormal imaging, according to a study published in the Journal of the American College of Radiology.

Researchers from Baylor College of Medicine in Houston, Texas performed a retrospective review to test whether certain aspects of communication in radiology reports influenced the response of the referring providers, and hence follow-up on abnormal findings.

Radiology reports from 250 patients were reviewed. The researchers focused on expressions of doubt in the radiology report and recommendations for further imaging. Follow-up was defined as one or more of the following, within four weeks of the original imaging:

• Patient notification of the test result

• Ordering or referral for recommended follow-up test or imaging study

• Follow-up test or consultation

• Documentation addressing abnormal imaging in the medical record

The results showed further imaging studies were recommended for 162 of all abnormal imaging studies (64.8%) compared with 88  (35.2%) that did not have these recommendations.

“Patients whose reports contained recommendations for further imaging were more likely to have been lost to follow-up at 4 weeks compared with patients without such recommendations,” the authors wrote. However, expressions of doubt in the radiology report did not affect how quickly follow-up was done.

The researchers pointed out that an earlier study had shown verbal communication regarding abnormal results could be more effective in obtaining timely follow-up for patients, however verbal communication is not always possible. They also noted that electronic communication could have a negative effect on follow-up because there may be ambiguity about who is responsible for follow-up and there may be too much information (information overload) with comprehensive EHRs.

“Abnormal imaging results with recommendations for additional imaging may be more vulnerable to lack of timely follow-up,” the researchers concluded. “Additional safeguards, such as tracking systems, should be developed to prevent failure to follow up on such results.”