Use of a clinical pathway to manage unsuspected radiographic findings.
OBJECTIVE
To describe our 5-year experience with a clinical pathway used to ensure the timely communication and evaluation of unsuspected radiologic findings (URFs) noted on clinically requested chest imaging.


METHODS
Prospective data collection on clinical practice.


METHODS
Academically affiliated Veterans Affairs medical center.


METHODS
Pulmonary physicians, nurses, and radiologists.


RESULTS
Over a period of 5 years, 1,629 URFs were referred to the pathway (from chest radiographs, 1,359 [83.4%]; from CT scans, 270 [16.6%]). Most URFs (78%) were nodules, with a specific diagnosis made in one third of URFs, and with a specific diagnosis thought to be clinically significant in another one third of URFs. The most common diagnosis was neoplasm, with over two thirds of these diagnoses being lung cancer. One third of lung cancers detected were either stage 1 or 2, with 1 in 17 of all URFs being stage IA lung cancer. The cost of the pathway was estimated at 28,600 dollars per year.


CONCLUSIONS
URFs noted on chest imaging are frequently clinically significant, and a systematic approach to managing URFs, such as a clinical pathway, can significantly improve care in a large teaching hospital.
Holden
William E
WE
Medical Service, Pulmonary and Critical Care Section, Portland Veterans Administration Medical Center, Portland, OR 97201, USA. william.holden@med.va.gov
Lewinsohn
David M
DM
Osborne
Molly L
ML
Griffin
Chris
C
Spencer
Ann
A
Duncan
Carol
C
Deffebach
Mark E
ME
D000368:Aged; D019091:Critical Pathways / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006784:Hospitals, Teaching; D006787:Hospitals, Veterans / Q000191:economics / Q000592:standards; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D009922:Oregon; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics / Q000592:standards*; D011873:Radiology Information Systems / Q000191:economics; D014481:United States; D014493:United States Department of Veterans Affairs