Adoption of a closed loop communication tool to establish and execute a collaborative follow up plan for incidental pulmonary nodules

PURPOSE: We designed a closed loop communication and tracking system (RADAR) to enable execution of a collaboratively developed care plan for follow up imaging of incidental pulmonary nodules (IPN). The system requires adoption by radiologists and referring providers. We assess radiologists’ adoption of RADAR and its impact on the clarity of radiologists’ follow up recommendations for IPN. METHODS: This Institutional Review Board-approved study was performed at a large, urban, tertiary care academic center performing 800,000 radiology examinations annually. Radiologists generate critical alerts for all newly discovered incidental pulmonary nodules using a previously described PACS-embedded software tool to track acknowledgement of receipt of critical alerts by ordering providers (i.e., usual care). RADAR (i.e., intervention) is a closed-loop communication tool, embedded in radiology PACS and enterprise provider workflow that enables establishment of a collaborative follow up plan (CFUP) between a radiologist and referring provider and helps automate the tracking and execution of CFUP. RADAR use is at the discretion of the interpreting radiologist. After implementation of RADAR for IPN in thoracic radiology (study period 3/9/2018–8/2/2018), we assessed RADAR adoption (primary outcome: #RADAR alerts for IPN/# of all alert for IPN). Secondary outcome was the clarity of follow up recommendation, defined as explicit documentation of the imaging modality and timeframe for follow up, as well as referring provider agreement with the recommendation. Trend over time was assessed with Cochran Armitage test. RESULTS: Post implementation, 106 of 183 (58%) IPN alerts were generated using RADAR. RADAR adoption increased by 75% during the study period (40% in first 3 weeks v 70% in last 3 weeks; ([70%−40%]/40%x100= 75%; p<0.001 test for trend). All RADAR alerts had explicit documentation of imaging modality and timeframe for follow up, compared to 71% for non-RADAR alerts for IPNs (p<0.001). CONCLUSION: Thoracic radiologists adopted a closed-loop communication system that allows for scheduling and automated tracking of pulmonary nodule follow-up recommendations. This system improved the quality of follow-up recommendations.