Beth Israel Lahey Hospital & Medical Center

Closing the Loop on Lung Nodule Follow-Up Recommendations

Project Lead: Pauley Chea, M.D.

Project AIM(s): Increase the rate of adherence to radiology follow-up recommendations for incidental lung nodules by 10% in 12 months.  (Success measured by the completion of the recommended follow-up scan within 3 months of the targeted time frame for follow-up). 

Narrative Description: 

A large percentage of patients with incidental lung nodules may not receive appropriate follow-up care, and miscommunication is partly to blame. With a follow up tracking and intervention program, such as the one that we implemented at our institution, more patients and their primary care providers will become aware of a follow up recommendation which was previously unknown to them. With a notification system using built in EMR messaging, e-mail or telephone call, follow up care rates can be improved thus reducing the chance of a missed or delayed cancer diagnosis and reducing medical liability. In addition, we have shown that revenue generated from a follow-up program is enough to achieve sustainability if navigator cost is appropriately budgeted.   

Additionally, when paired in groups where the individual project aims and goals vastly differed, I found it difficult to offer advice for domain specific problems.  

For future or alternate grant programs, I wonder if it may be more effective to organize under a narrower set of the most important healthcare problems, call groups to propose solutions to these specific problems, and then over the year have these groups share their experiences in trying to solve the same problems. However, I believe there is still value in sharing common organizational and process challenges even among projects that have different specific aims.  

Diagnostic quality problem type, failure, or category (symptoms, observed problems, gaps in performance) addressed by the intervention

  • Information gathering
  • Information integration
  • Information interpretation
  • Establishing an explanation (diagnosis)
  • Communicate the explanation to the patient

Root causes/causative factors addressed by the intervention

  • Patient-clinician interaction (includes patient and family engagement)
  • Workflow (includes testing, follow-up, and referrals)
  • Health information sharing and accessibility via health IT
  • Knowledge gaps/inexperience

Setting of the diagnostic quality improvement intervention

  • Ambulatory medical care setting (e.g., clinic, office, urgent care)