Automatic referral program keeps tabs on lung cancer patients

A few keystrokes at the end of a dictated report could help solve one of radiology's most persistent problems: making sure reports on high-risk patients don't fall through the cracks and miss follow-up.

Radiologists at Royal Liverpool and Broadgreen University Hospital use a precoded paragraph to alert referring physicians and a case management nurse about patients whose chest x-rays suggest a high risk for lung cancer.

"Failure to get an abnormal report to the attention of referring physicians may have legal consequences," said presenter Dr. Conall Garvey. "The Florida Radiology Society estimates that 75% of cases against radiologists were based on communication issues."

Upon reading a suspicious chest film, radiologists include a code in the report that adds a paragraph advising the patient's primary physician to enroll the patient in the hospital's lung clinic. All coded cases are forwarded to the clinic's lung cancer nurse, who follows up with referring physicians and, at their request, calls patients to enroll them in the clinic. On lung clinic days, patients can undergo CT, biopsy, or bronchoscopy, with same-day results.

For the first 453 patients flagged by the system, it took a median 11 days from first report to an appointment at the lung clinic. Two-thirds of the patients seen had a malignancy.

Because the hospital has the lung program already in place, there is little expense in terms of money or time for radiologists, Garvey said Saturday at the ECR. Most referring physicians seem to like having the next step in patient assessment laid out for them, and the nurse coordinator is already assigned.