Develop, follow policy
There are many schools of thought on the best ways to manage incidental findings, and the best answer for one organization may not be the best for another. What is important is that health care organizations develop a policy on how incidental findings are routed and communicated, and systematically audit that the policy is being followed. If asked in court why you did not follow up on a particular finding, pointing to an institutional policy is more of a defense than having no reason at all.
If you are in receipt of a radiology report documenting an incidental finding, you should not assume that another provider has dealt with it unless you see clear documentation of this in the medical record. If it is a finding outside of your specialty, it would be prudent to communicate this information to the patient’s primary care or admitting physician, with a note in the chart to memorialize the communication. If the patient is not established in your organization, make sure the patient has a copy of the radiology report and document that he or she has been told how to best follow up. This way, if the patient chooses to do nothing with this information, you have helped to insulate yourself from litigation.
Incidental radiology findings are low-hanging fruit that organizations should develop processes for handling proactively. Although a great number of these findings are benign and will remain benign, the small number that turn into cancers or other growths requiring surgical intervention or significant medical treatment have the potential to become low-hanging fruit for a plaintiff’s attorney.
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