In this study we: 
Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma
Propose simple solutions to increase the rate of disclosure to patientshttps://jdc.jefferson.edu/patientsafetyposters/1070/thumbnail.jp

Alswealmeen, W.

Bertozzi, D.

Gartner, L.

Kirton, O.

Lim, P.

Rogers, A.

Sabapathi, P.

Shadis, R.

Sich, N.

Sternlieb, J.

Yuschak, J.

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters Quality Improvement & Patient Safety Initiatives5-31-2017Filling the Void: A Low Cost, High-Yield Methodto Addressing Incidental Findings in TraumaPatientsN. SichAbington Jefferson HealthA. RogersAbington Jefferson HealthD. BertozziAbington Jefferson HealthP. SabapathiAbington Jefferson HealthL. GartnerAbington Jefferson HealthSee next page for additional authorsFollow this and additional works at: https://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationSich, N.; Rogers, A.; Bertozzi, D.; Sabapathi, P.; Gartner, L.; Alswealmeen, W.; Lim, P.; Sternlieb, J.; Yuschak, J.; Kirton, O.; and Shadis,R., "Filling the Void: A Low Cost, High-Yield Method to Addressing Incidental Findings in Trauma Patients" (2017). House StaffQuality Improvement and Patient Safety Posters. Poster 38.https://jdc.jefferson.edu/patientsafetyposters/38AuthorsN. Sich, A. Rogers, D. Bertozzi, P. Sabapathi, L. Gartner, W. Alswealmeen, P. Lim, J. Sternlieb, J. Yuschak, O.Kirton, and R. ShadisThis poster is available at Jefferson Digital Commons: https://jdc.jefferson.edu/patientsafetyposters/38Background • Due to fear of a missed injury, the tendency to “Pan CT” has dramatically increased. • This leads to a rise in incidental findings, or findings on imaging not related to the original indication of the study. • There are few studies assessing incidentals outside of urban populations and level one trauma centers. • There are even fewer studies attempting to address how to handle reporting incidental findings to patients, with some studies having rates as low as 10%.  Pre-Intervention:    Retrospective chart review from Oct 1st 2015 to March 31st 2016  All charts hand reviewed by investigators ◦Age, # of CT scans, type of CTs, # of incidental findings, category of incidental finding, if radiology recommended follow up, and if the patient was informed of the finding  Category 1 and 2 Incidental Findings were considered significant (requiring follow up prior to discharge or interval follow up);     Category 3 were clinically insignificant  Implementation of Multi-Disciplinary Systems Changes ◦ Radiology driven changes ◦ Informatics driven changes ◦ Standardized protocol for trauma residents/front-line providers ◦Utilization of existing work-flows for patient & primary communication  Post-Intervention:     Retrospective chart review from Sept 1st 2016 to Nov 30st 2016 ◦Data collected in same fashion as pre-intervention ◦Additional stratification including follow up revenue from CMS reimbursement, if patient had known about significant incidentals, and new diagnoses of malignancy per three month period      Improving Capture of Incidental Findings Nicholas Sich PGY-2 Abington General Surgery, Patient Safety and Quality Officer Department of Surgery, Abington Memorial Hospital, 1200 Old York Road  Filling the Void: A Low Cost, High-Yield Method to Addressing I cidental Findings in Tr uma Patients Sich N, Rogers A, Bertozzi D, Sabapathi P, Gartner L, Alswealmeen W, Lim P, Sternlieb J, Yuschak J, Kirton O, Shadis R Abington-Jefferson Health, Abington PA 19090 Methods Results Conclusion Acknowledgements / Select References In this study we: • Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma • Propose simple solutions to increase the rate of disclosure to patients  Table 2 – Categorized Significant Incidental Findings Type of SIF # of Incidentals Pre % of Total Incidentals Pre # of Incidentals Post % of Total Incidentals Post Lung Nodules, Lesions, Masses Thyroid Nodules, Thyromegaly 90  53 23%  13%  72  52  22%  16%  Lymphadenopathy (Cervical, Chest, Abd) 39 10% 16 5% Aortic Aneurysms (Thoracic, Abdominal) 31 8% 18 5% Renal Nodules, Lesions, Masses 25 6% 25 8% Adrenal Nodules, Lesions, Masses 22 6% 20 6% Liver Nodules, Lesions, Masses 18 5% 20 6% Other Suspicious Masses 18 5% 13 4% Adnexal Cyst, Lesions, Masses 12 3% 15 5% Pancreatic Lesions, Mass, Dilation, Cyst 12 3% 15 5% Brain Lesions (Meningioma, NPH) 11 3% 13 4% Bone Lesions (Destructive, Sclerotic) 10 3% 13 4% Bladder Thickening, Mass, Hydronephrosis 9 2% 8 2% Other (Breast, Soft Tissue, Misc. Facial) 54 14% 49 15%  Table 4 – Follow Up Imaging, Specialists, Procedures for SIFs. Required F/U Modality # of Patients Example Specialist for F/U # of Patients Example CT Thorax 42 Pulmonary Nodule CT Surgery 10 Thoracic Aneurysm CT Abd/Pelvis 8 Adrenal Nodule ENT 1 Thyroglossal Cyst US Thyroid 32 Thyroid Nodule Gastroenterology 11 Biliary Dilation US Pelvis 16 Adnexal Cyst Gen Surgery 2 Incarcerated Hernia US Retroperit 12 Renal Mass Gynecology 4 Adnexal Mass MRI Abd 34 Pancreatic Cyst Neurosurgery 3 NPH MRI Brain 4 Brain Mass Neurovascular 1 Berry Aneurysm MRI Spine 5 Sclerotic Lesion Oncology 8 New Metastasis Pet CT 8 Pulmonary Nodule Ophthalmology 1 Orbital Mass Other Imaging 10 RUQ/Carotid US Rad/Onc 1 New Metastasis Endoscopy 7 GI Mass Urology 12 Hydronephrosis Other Proc 7 IR Bx, FNA Vascular Surgery 9 Iliac Aneurysm, AAA  Table 1 – Patients, CTs, and Incidental Findings in the Pre-Intervention Arm Stratified by Age.  # of Patients # of CTs # of Incidental Findings # of Patients with Incidental Findings Mean # of Incidentals per Patient # of Patients with Significant Incidental Total <65 674 292 (43%) 2533 1104 1273 304 456 (70%) 156 (53%) 1.9/patient 1.0/patient 246 (36%) 70 (24%) >65 382 (57%) 1429 969 300 (79%) 2.5/patient 176 (46%)  Table 3 – Follow Up Recs and Documented Disclosure Pre- and Post- Intervention (p<0.00001).  # of Patients with SIF # of SIF Radiologist Provided F/U Recommendations Documented that SIF was Disclosed Radiologist Provided F/U and Documented Disclosure Pre- Post- 246 225 396 352 86 (22%) 225 (68%) 105 (27%) 281 (85%) 28 (7%) 133 (59%)  Revenue Generated in F/U Imaging: $37,119 for three months, or approximately $150,000/yr for Trauma New Malignancies Detected: 20 new malignancies and 5 new metastasis, or approximately 100 patients/yr (4%)  Previous studies in urban trauma populations demonstrated a rate of incidental findings from 15-50%. This study shows that this is a significant underestimation and is not likely reflective of the vast majority of trauma centers that treat primarily blunt/elderly trauma.  Simple systems based changes can be implemented with minimum amount of resources and effort. These changes will not only have a profound impact on improving reporting of incidentals to patients, but also generate additional hospital revenue, protect providers from medico-legal ramifications of failing to disclose, and most importantly improve patient care. This method is not limited to trauma surgery and can be applied to any service.  Further iterations and innovations are needed to refine this process and define the most cost-efficient method of ensuring patients are aware of incidental findings in their imaging studies.  Special thanks to Maureen Small, our Trauma Program Manager who assisted with data collection. We would also like to thank Drs. Josloff, Noonan, and the entire General Surgery Safety/Quality Committee who helped turn this idea from a project into a reality.  Baugh KA, Weireter LJ, Collins JN. The trauma pan scan: what else do you find? Am Surg. 2014;80(9):855-859.  Munk M-D, Peitzman AB, Hostler DP, Wolfson AB. Frequency and Follow-up of Incidental Findings on Trauma Computed Tomography Scans: Experience at a Level One Trauma Center. J Emerg Med. 2010;38(3):346-350.   Yeh DD, Imam AM, Truong SH, et al. Incidental Findings in Trauma Patients: Dedicated Communication with the Primary Care Physician Ensures Adequate Follow-Up. World J Surg. 2013;37(9):2081-2085.  Sperry JL, Massaro MS, Collage RD, et al. Incidental radiographic findings after injury: Dedicated attention results in improved capture, documentation, and management. Surgery. 2010;148(4):618-624.  Berland, LL. Overview of White Papers of the ACR Incidental Findings Committee II on Adnexal, Vascular, Splenic, Nodal, Gallbladder, and Biliary Findings. J Am Coll Radiol. 2013;10:672-674.  Figures – A) Example of new Radiology Report. B) Modified Trauma H&P. C) Follow-Up Order.  D) Discharge Instructions. 

Filling the Void: A Low Cost, High-Yield Method to Addressing Incidental Findings in Trauma Patients

In this study we: 
Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma
Propose simple solutions to increase the rate of disclosure to patientshttp://jdc.jefferson.edu/patientsafetyposters/1070/thumbnail.jp

Name not available

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1070&amp;context=patientsafetyposters

Filling the Void: A Low Cost, High-Yield Method to Addressing Incidental Findings in Trauma Patients

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