Allison Aase1, Angela E Fabbrini2, Katie M White3, Sarah Averill4, Amy Gravely5, Anne C Melzer6. 1. University of Minnesota School of Public Health, Minneapolis, Minnesota; Section of Pulmonary, Allergy Sleep and Critical Care, Minneapolis VA Health Care System, Minneapolis, Minnesota. 2. Section of Pulmonary, Allergy Sleep and Critical Care, Minneapolis VA Health Care System, Minneapolis, Minnesota. 3. University of Minnesota School of Public Health, Minneapolis, Minnesota. 4. Department of Radiology, Iowa City VA Health Care System, Iowa City, Iowa. 5. Primary Care Service Line, Minneapolis VA Health Care System, Minneapolis, Minnesota. 6. Section of Pulmonary, Allergy Sleep and Critical Care, Minneapolis VA Health Care System, Minneapolis, Minnesota; Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota School of Medicine, Minneapolis, Minnesota. Electronic address: anne.melzer2@va.gov.
Abstract
OBJECTIVE: Incidental pulmonary nodules (IPNs) are common. Up to 70% are not followed up according to current guidelines. Follow-up recommendations are based on the characteristics of the patient and the IPN. However, many IPNs are incompletely characterized in CT reports. Structured radiology reports have been shown to reduce missing information. We sought to improve IPN reporting by assessing the feasibility, acceptability, and effectiveness of a structured dictation template to increase the presence of six key nodule descriptors. METHODS: We performed a mixed methods, pre- and postimplementation assessment. A template was developed with a multidisciplinary group based on Fleischner Society guidelines. A standardized checklist was used to determine the presence of documented descriptors pre- and postimplementation for sequential radiology reports of patients with an IPN present (n = 400 pre-implementation and n = 400 postimplementation) on a CT performed at the Minneapolis Veterans Affairs Health Care System. We conducted qualitative interviews with radiologists (n = 4) and members of the lung nodule tracking team (n = 2) to elicit their experiences of the template implementation process. RESULTS: The proportion of radiology reports including all six elements increased from 12% to 47% (P < .001). Postimplementation, the template was used in 40% of interpretations involving lung nodules, 67% of follow-up scans, and 8% of initial identifications. Response to the template was overall positive. DISCUSSION: Use of a dictation template seems to be effective in increasing compliance with full IPN documentation, streamlining the follow-up process. Low utilization rates of the template for initial nodule identification is a limitation, which may be combated through clearer communication and advances in technology. Published by Elsevier Inc.
OBJECTIVE: Incidental pulmonary nodules (IPNs) are common. Up to 70% are not followed up according to current guidelines. Follow-up recommendations are based on the characteristics of the patient and the IPN. However, many IPNs are incompletely characterized in CT reports. Structured radiology reports have been shown to reduce missing information. We sought to improve IPN reporting by assessing the feasibility, acceptability, and effectiveness of a structured dictation template to increase the presence of six key nodule descriptors. METHODS: We performed a mixed methods, pre- and postimplementation assessment. A template was developed with a multidisciplinary group based on Fleischner Society guidelines. A standardized checklist was used to determine the presence of documented descriptors pre- and postimplementation for sequential radiology reports of patients with an IPN present (n = 400 pre-implementation and n = 400 postimplementation) on a CT performed at the Minneapolis Veterans Affairs Health Care System. We conducted qualitative interviews with radiologists (n = 4) and members of the lung nodule tracking team (n = 2) to elicit their experiences of the template implementation process. RESULTS: The proportion of radiology reports including all six elements increased from 12% to 47% (P < .001). Postimplementation, the template was used in 40% of interpretations involving lung nodules, 67% of follow-up scans, and 8% of initial identifications. Response to the template was overall positive. DISCUSSION: Use of a dictation template seems to be effective in increasing compliance with full IPN documentation, streamlining the follow-up process. Low utilization rates of the template for initial nodule identification is a limitation, which may be combated through clearer communication and advances in technology. Published by Elsevier Inc.
Entities:
Keywords:
Fleischner Society guidelines; incidental pulmonary nodule; process implementation; standardized reporting
Authors: Allard W Olthof; Anne L M Leusveld; Jan Cees de Groot; Petra M C Callenbach; Peter M A van Ooijen Journal: J Med Syst Date: 2020-07-28 Impact factor: 4.460