Background: Incidental pulmonary nodules (IPNs) are lung nodules detected on imaging studies performed for an unrelated reason. Approximately 1.6 million IPNs are detected in the United States every year. Unfortunately, close to 1.1 million (69%) of these IPNs are not managed with appropriate follow-up care. The goal of this study was to assess the utility of a noncommercial electronic medical record (EMR)-based IPN keyword recognition program in identifying IPNs and the ability of lung navigators to communicate these findings to patients.Methods: This is a observational, implementation study aimed identify IPNs using an EMR-based protocol and to relay results of findings to patients. The patient population included patients 16 and older undergoing computed tomography (CT) chest, CT chest/abdomen, CT angiogram chest, CT chest/ abdomen/pelvis, and chest radiography through the radiology department within a large community tertiary medical campus between June 2019 and August 2020. EPIC EMR were queried using criteria designed to find IPNs. A lung navigator reviewed these cases and sorted them into categories based on their size and risk status. After identification of risk factors, actions were taken to directly communicate results to patients.Results: Seven hundred and fifty-three patients were found to have true IPNs without a history of active malignancy involving the lung. On the basis of radiographic measurements, 60% of the nodules identified were <6 mm, 17% were between 6 and 8 mm, 22% were > 8 mm, and 12% were deemed nodular opacities. Lung navigators were able to contact a total of 637 (87%) individuals with IPNs and results were directly communicated. Of the 637 patients identified to have an IPN, a total of 12 (2%) cancers were diagnosed. Conclusion:We have here demonstrated that the development of an EMR-based keyword recognition platform for the identification of IPNs is a useful and successful tool for communication of IPN findings to patients using lung navigators.

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Background: Endobronchial ultrasound bronchoscopy (EBUS) is a minimally invasive procedure using real-time imaging to biopsy malignant and benign lesions within the thoracic cavity. While physicians rely heavily on the degree of training to obtain EBUS procedural proficiency, patients may not consider training to be the primary factor that influences the physician they choose. Traditionally, patients undergoing any medical procedure assume that the treating physician has completed standardized training and is proficient in procedural techniques. Because there is no standardized training for EBUS, patients cannot necessarily rely on the level of training of the physician performing the procedure. This survey-based study examines factors that were most and least important to patients regarding the physician who would be performing their EBUS bronchoscopy. Methods: Using best-worst scaling (BWS), object case methods (case 1; Louviere et al, 2015), a survey was developed with a balanced incomplete block design (BIBD): 11 objects (Figure 1), repeated 5 times across 11 sets with a set size of 5 and co-occurs with the other 10 objects twice. In the survey, titled EBUS Patient Preference Survey, participants were instructed to identify the factors (objects) that were most and least important to them when making arrangements for an EBUS procedure. The data was analyzed by calculating a normalized best-worst (NBW) score for the total sample/aggregate for each object. The data was also analyzed as a percentage distribution on the proportion selected as most versus least important versus never selected (denominator = 930). Analyses were conducted using SPSS (IBM Corp, Version 26.0). Results: Of the 193 patients who consented, 3 withdrew due to the length of the survey and 4 incorrectly completed the survey, resulting in a sample size of 186. The overall sample felt that a doctor who communicated well was most important to them when arranging for an EBUS procedure, followed by a physician with more years of experience performing EBUS, referral from their doctor, and procedure performed in a specialized facility. ). The least important factor when arranging for an EBUS procedure was out of pocket cost for procedure, time to scheduling, and positive doctor rating online. Conclusions: Our study reveals that patients prefer physicians who communicates well, has more years of experience performing EBUS, and was referred to by their physician to be the most important factors when choosing an EBUS proceduralist