title: Lack of timely follow-up of abnormal imaging results and radiologists' recommendations.
abstract: OBJECTIVE
  Abnormal imaging results may not always lead to timely follow-up. We tested whether certain aspects of communication in radiology reports influence the response of the referring providers, and hence follow-up on abnormal findings.
  
  
  METHODS
  We focused on 2 communication-related items that we hypothesized could affect follow-up: expressions of doubt in the radiology report, and recommendations for further imaging. After institutional review board approval, we conducted a retrospective review of 250 outpatient radiology reports from a multispecialty ambulatory clinic of a tertiary-care Veterans Affairs facility. The selected studies included 92 cases confirmed to lack timely follow-up (ie, further tests or consultations, treatment, and/or communication to the patient within 4 weeks), as determined in a previous study. An additional 158 cases with documented timely follow-up served as controls. Doubt in the narrative was measured by the presence of key phrases (eg, "unable to exclude," "cannot exclude," "cannot rule out," "possibly," and "unlikely"), in the absence of which we used reviewer interpretation. A physician blinded to follow-up outcomes collected the data.
  
  
  RESULTS
  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 (P = .01). Language in the report suggestive of doubt did not affect the timeliness of follow-up (P = .59).
  
  
  CONCLUSIONS
  Abnormal imaging results with recommendations for additional imaging may be more vulnerable to lack of timely follow-up. Additional safeguards, such as tracking systems, should be developed to prevent failure to follow up on such results.
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA. Electronic address: almutair@bcm.edu.
authors.forename: Aymer
authors.initials: A
authors.lastname: Al-Mutairi
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Ashley N D
authors.initials: AN
authors.lastname: Meyer
authors.affiliation: Division of Radiology Informatics, Department of Radiology, University of Chicago Medical Center, Chicago, IL.
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003142:Communication; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D007802:Language; D059012:Lost to Follow-Up; D011871:Radiology / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013781:Texas; D013997:Time Factors
keywords: Follow-up; abnormal tests; diagnostic error; doubt; radiology reporting