Optimal Management Strategy for Incidental Findings in Trauma Patients: An Initiative for Midlevel Providers

Huynh, Toan; Moran, Kelly; Blackburn, Angela; Jacobs, David; Thomason, Michael; Sing, Ronald F.

doi:10.1097/ta.0b013e31817e5153

Cited by 14 publications

(30 citation statements)

References 12 publications

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“…Prior literature regarding the management of IFs have looked at the use of midlevel providers to perform tertiary trauma surveys once admitted and to notify those patients at that time prior to discharge with appropriate follow-up plans 20. Although this prior study was descriptive in nature with no comparison group or method of verifying their IF capture completeness, their conclusions are similar to the conclusions of this current analysis.…”

Section: Discussionmentioning

confidence: 52%

Incidental radiographic findings after injury: Dedicated attention results in improved capture, documentation, and management

Sperry

Massaro

Collage

et al. 2010

Surgery

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Objective-With liberal use of computed tomography in the diagnostic management of trauma patients, incidental findings (IFs) are common and represent a major patient care and medical-legal concern. Consequently, we began an initiative to adequately capture, notify, and document IF events with a dedicated incidental finding (DIF) coordinator. We hypothesized a DIF coordinator would increase IF capture and promote notification, follow-up and documentation of IF events.Methods-A quality improvement project to record and follow-up IFs post-injury was initiated at our level I trauma center (4/07-3/08, PRE-DIF). Due to concerns for inadequate documentation of identified IF events we implemented a DIF coordinator (4/08-3/09, POST-DIF). The DIF coordinator documented IFs daily from trauma admission radiology final reads. IFs were divided into 3 groups, Cat 1: attention prior to discharge, Cat 2: follow-up with primary doctor within 2 weeks, Cat 3: no specific follow-up. For Cat 1 IFs, in-hospital consultation of the appropriate service was verified. Upon discharge, patient notification, follow-up and documentation of events were confirmed. Certified mail or telephone contact was used to notify either the patient or primary doctor in those who lacked appropriate notification or documentation.Results-Admission rates and IF Categories were similar across the two time periods. Implementation of a DIF coordinator resulted in over a 165% increase in IF capture (n=802 vs. n=302, p< 0.001). Patient notification was attempted and appropriate documentation of events was confirmed in 99.8% of patients. Patient notification was verified and follow-up was initiated in 95.8% of cases.Conclusion-Implementation of a DIF coordinator resulted in over a 2.5-fold higher capture of IFs. Dedicated attention to IFs resulted in near complete initiation of patient notification, follow-up, and hospital record documentation of IF events. Inadequate patient notification and follow-up would delay appropriate care and potentially result in morbidity or even mortality. A dedicated incidental finding coordinator represents a potential solution to this patient care and medical-legal dilemma.

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Section: Discussionmentioning

confidence: 52%

Incidental radiographic findings after injury: Dedicated attention results in improved capture, documentation, and management

Sperry

Massaro

Collage

et al. 2010

Surgery

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“…31 Systematic approaches to the management of the incidental renal mass have been well described and helpful classifi cations have been in use for many years. Nonetheless, the frequency of renal cysts, an entity also felt to be clinically significant by Huynh and colleagues, 30 being detected in 17% (n ϭ 70) of all patients reviewed, has marked workload implications. Even if no follow-up is required, categorization and education mandate a sensible, organized, and realistic management approach, all of which consumes human resources.…”

Section: Discussionmentioning

confidence: 91%

“…One hypothesis as to why our rates of IFs were so remarkable may relate to our holistic approach of considering all diagnostic modalities including clinical examination, similar to the work of Huynh and colleagues. 30 Other reviews of IFs have limited their considerations to specifi c modalities focused on one anatomic region such as just abdominal CTs, which will capture a relevant but only partial component of the challenge. 4 System weaknesses were noted to compound both the workload and potential for missing IFs altogether.…”

Section: Discussionmentioning

confidence: 99%

Management of Incidental Findings in the Trauma Patient

Biegler

McBeth

Tiruta

et al. 2012

Journal of Trauma Nursing

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“…Therefore, the categorization of missed injuries may be somewhat overzealous in this analysis. Despite this, the importance of a tertiary survey [10] prior to discharge should not be de-emphasized and would have been potentially advantageous in several of the ten cases.…”

Section: Discussionmentioning

confidence: 99%

Trauma Patient Unplanned Hospital Re-Admissions

Esposito¹,

Clark-Kula²,

Crowe³

et al. 2012

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Introduction: Performance monitoring and performance improvement (PI) are increasingly important. Little is known regarding unplanned re-admission (UPR) in trauma patients. This study characterizes UPRs at one institution. Methods: Retrospective descriptive review of UPR to a Level I Trauma Center Information was obtained on: initial trauma diagnoses, diagnosis precipitating UPR, discharge interval, treatment rendered and length of stay (LOS) during both encounters, and PI committee judgments. Characteristics of UPR patients were determined and compared to those of all discharged patients. Descriptive statistics were applied. Results: Over 2.5 years there were 2827 discharges and 58 UPR(2%). The majority of original diagnoses were related to blunt trauma and head injuries. UPR occurred at a median of 3 days, with 54% re-admitted to the trauma service. Operative rate for UPR patients during the initial admission was 48% with 28%requiring operation on the UPR. Headache and wound issues were responsible for 42% of UPR. Diagnosis precipitating UPR was primarily related to post-operative complications in 26% of all UPR and 57% of those undergoing operation on the initial admission. Median LOS for UPR was 3days with ICU care being required by 13%. Of all UPRs,33% were attributable to opportunities for improved care (OFI) during the first admission. Identified OFIs were related to errors in technique (53%), errors in judgment (27%), and system issues (20%). Of UPR without OFI, 87% were related to disease and13% systems issues. Conclusion: UPR at a Level I trauma center is rare, occurs shortly after discharge, is brief in duration and usually related to postoperative wound issues or headache. Post operative patients seem at greater risk for UPR. While most UPR are considered non-preventable, attention to discharge instructions,patient education, resident education and supervisionand outpatient support, may obviate a number of preventable UPRs

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Optimal Management Strategy for Incidental Findings in Trauma Patients: An Initiative for Midlevel Providers

Cited by 14 publications

References 12 publications

Incidental radiographic findings after injury: Dedicated attention results in improved capture, documentation, and management

Incidental radiographic findings after injury: Dedicated attention results in improved capture, documentation, and management

Management of Incidental Findings in the Trauma Patient

Trauma Patient Unplanned Hospital Re-Admissions

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