No stone unturned: Nodule Net, an intervention to reduce loss to follow-up of lung nodules. (October 2019)

• Record Type: Journal Article
• Authors: Weinstock, T.G.; Tewari, A.; Patel, H.; Kelley, K.; Tananbaum, R.; Flores, A.; Shah, A.T.; Abujaber, S.Y.; Khorashadi, L.; Shortsleeve, M.J.; Thomson, C.C.
• Is Part Of: Respiratory medicine. Volume 157(2019)
• Page Start: 49
• Page End: 51
• Publication Date: 2019-10
• Subjects: Lung nodules -- Lung cancer; Lung cancer -- Lung nodules; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2019.09.003
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Objective: Inadequate lung nodule surveillance leads to diagnostic delays. We implemented a retrospective intervention program, Nodule Net, to improve surveillance in our hospital. Methods: 9, 224 Chest computed tomography (CT) scans between January 1, 2015 and December 31, 2016 were manually reviewed for lung nodules. For patients without follow-up, charts were reviewed to assess follow-up. If follow-up appeared indicated, the clinician or patient was contacted, and follow-up was tracked. Results: Lung nodules were identified on 5, 101 (55%) of 9, 224 scans. Follow-up was potentially indicated and not completed in 1, 385 (27%). 183 (13%) were excluded after imaging review. 1, 202 received outreach. Of the 801 (66%) with a provider in our system, 225 (27%) returned for follow-up. Nodules were stable in 199 (88%), new or growing in 23 (11%), resolved in 3 (1%), and stage 1 lung cancer in 2 (1%). 90 (11%) had follow-up outside our system and 431 (51%) had no follow-up due to a clinical contraindication. 55 (7%) have imaging pending and 14 (2%) are awaiting pulmonary evaluation. Of the 302 (25%) patients with providers outside our system, 121 (40%) had followed-up elsewhere. 146 (48%) had no follow-up due to a clinical reason. 35 (12%) providers did not respond to outreach. Conclusions: We identified 1, 202 patients with lung nodules who needed follow-up over a two-year period. Compliance was more successful with providers within our hospital system. We recommend robust surveillance for patients to ensure follow-up is completed and clinical contraindications are well documented. Highlights: 9, 224 chest CT scans were reviewed. 27% of patients had no follow-up completed. 12% of returning patients had developed new or growing nodules. Two patients with stage 1 lung cancer were identified through outreach.