71PD Emergency department incidental lung nodule follow up: A best practice initiative

Abstract

Background: Early detection of lung nodules may lead to prompt diagnosis and treatment of lung cancer, improving patient outcomes. We instituted and evaluated a lung nodule best practice initiative that would coordinate between the emergency department (ED) visits where a long nodule was detected and follow up care post discharge. Methods: CT scan of the chest was assessed after completion of ED evaluation. If a lung nodule was detected; patient was made aware of the findings by ED clinician. Documentation supported by ED clinician choosing a box reporting lung nodule detected prior to discharge in the ED electronic medical record (EMR). A daily email was automatically generated to the thoracic nurse navigator (TNN). TNN called the patients to offer: appointment to the lung nodule clinic, assignment with primary physician, or patient declined options. TNN documented conclusion in EMR. A certified letter was sent to the patient as a recommendation and summary. Results: 287 patients were listed on the ED lung nodule report from 11/1/2016–12/31/2017. 45 patients listed did not have a true nodule and were excluded, resulting in 242 patients. 12 (4.9%) patients were referred to the Lung Center Nodular Clinic. 176 (72.7%) patients were referred to other physicians, such as pulmonary and primary care physicians. 78% of incidental pulmonary nodules from the ED was referred for follow up. 54 patients either declined follow up or were unable to be reached. There were 2 days of blank reports from the ED. A review of both RAD (report from radiology) and ED reports were compared for the week 11/20–11/27/17. 31 patients with nodules on RAD reports were missing from the ED version: 18 from the day shift and 13 on night shift. These missing patients indicate many more nodule patients were not accurately reported. Since the ED account relies on manual check box, the TNN now runs ED reports against the RAD versions for correct number of patients with incidental pulmonary nodules. Conclusions: Many incidental lung nodules are discovered nationwide through the emergency department. Many of these go without follow up. We demonstrate an initiative that implements a verifiable system along the pathway in the emergency department through discharge home. Legal entity responsible for the study: Jupiter Medical Center, Dept of Thoracic Surgery Funding: Has not received any funding Disclosure: The author has declared no conflicts of interest.