System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings

UMMS Affiliation

Department of Radiology; Department of Emergency Medicine

Publication Date


Document Type



Emergency Medicine | Health and Medical Administration | Health Services Administration | Radiology


The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method. We assembled a multidisciplinary team to address the nature of these incidental findings and designed new workflows and operational pathways for both radiology and ED staff to properly communicate incidental findings. Our results are based on all incidental findings received and acknowledged between November 1, 2016, and May 30, 2017. The total number of incidental findings discovered was 1,409. Our systematic compliance fluctuated between 45% and 95% initially after implementation. However, after overcoming various challenges through optimization, our system reached a compliance rate of 93% to 95%. Through the implementation of our new, standardized communication system, a high degree of compliance with loop closure for ED incidental radiology findings was achieved at our institution.


Incidental findings, communication, emergency department, patient safety, radiology, system implementation

DOI of Published Version



J Am Coll Radiol. 2018 Jan 3. pii: S1546-1440(17)31485-0. doi: 10.1016/j.jacr.2017.11.031. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American College of Radiology : JACR


See also this blog post in Health Imaging about this article.

Related Resources

Link to Article in PubMed

PubMed ID