A Collaborative Emergency Medicine and Radiology Pulmonary Nodule Program: Identification of Associated Efficacy and Outcomes

Incidental radiology findings are commonplace but the episodic nature of ED care makes it challenging to ensure patients obtain appropriate follow-up. Rates of follow-up range from 30-77%, with some studies finding that over 30% have no follow-up at all. We aim to describe and analyze the outcomes of a collaborative Emergency Medicine and Radiology initiative to establish a formal work flow for the follow-up of pulmonary nodules identified during ED care. We performed a retrospective analysis of patients referred to the pulmonary nodule program (PNP). Patients were divided into two categories - those with follow-up, and those who do not have post-ED follow-up. Our primary outcome was determining follow-up rates and outcomes, including patients referred for biopsy. We also comparatively examined the characteristics of patients who completed follow-up verses those lost to follow-up. A total of 574 patients were referred to the PNP. 390 (69.1%) had initial follow-up established. 30.8% were considered lost to follow-up and over half of these patients did not respond to initial contact. There was minimal difference in characteristics between patients in these two categories. Of the 259 patients who completed PNP follow-up, 26 were referred for biopsy (13%). The PNP provided effective transitions of care and potentially improved patient healthcare. Strategies to further enhance follow-up compliance will provide iterative improvement of the program. Our program provides an implementation framework for post-ED pulmonary nodule follow-up at other healthcare systems, or could be modified for use with other incidental diagnostic findings.