Communicating Incidental Findings

An incidental finding is an unexpected result discovered during a medical examination or imaging study that is unrelated to the original reason for the test. These findings are often unanticipated and may reveal previously undiagnosed conditions, such as tumors, cysts, or other abnormalities. While some incidental findings may be benign and not require intervention, others can be clinically significant and necessitate further evaluation or treatment to prevent potential health risks. The challenge lies in determining which incidental findings are important to address and ensuring proper communication and follow-up.

 

Why It Matters

When identified and addressed properly, incidental findings may provide lifesaving benefits by alerting a patient about an unknown condition. But mismanagement of these findings at any stage of the care continuum may lead to a missed or delayed diagnosis, sometimes with catastrophic outcomes. Diagnostic accuracy relies on clear and precise communication throughout each stage of the test ordering and tracking process to ensure that all relevant information, including incidental findings, is fully conveyed to both the ordering practitioner and the patient.

 

Risk Recommendations

 

Develop an Incidental Finding Process

• Establish clear protocols for handling incidental findings based on their clinical significance, urgency, and potential impact on patient care.
• Assess clinical significance by evaluating the incidental finding for its clinical relevance. If needed, consult with specialists to determine whether it requires immediate action, further evaluation, or monitoring over time.
• Conduct regular audits to review how incidental findings are managed and resolved. Identify any gaps in the process and implement necessary improvements.

 

Ensure Clear and Direct Communication

• Notify the referring practitioner and other relevant healthcare practitioners immediately when an incidental finding is detected.
  • Use automated systems in the electronic health record (EHR) to generate incidental findings notifications.
• Communicate urgent and critical incidental findings.
  • Implement a process to prioritize unexpected and critical findings. 
  • Provide a concise explanation of the finding and whether it warrants further investigation or treatment.
  • Encourage practitioners who report incidental findings to discuss findings and their implications with the ordering and primary care practitioners when needed.
• Create an escalation protocol for when the ordering practitioner is unreachable.

 

Document the Communication   

• Standardize protocols for documenting incidental findings in reports and the EHR to ensure consistency and accuracy across the care continuum in alerting the ordering practitioner and all other practitioners, such as primary care.
• Include communication method and timing of critical findings. Record the:
  • Date.
  • Time.
  • Information provided.
  • Person who communicated the information. 

 

Highlight Incidental Findings in Reports

• Clearly distinguish critical incidental findings in the radiology report. 
  • Emphasize incidental findings and their recommendations by separating them from the rest of the report to draw attention to those findings.
  • Use dedicated sections or headings such as "Critical Findings" to help ensure that the referring healthcare practitioner promptly notices and acts upon the findings.

 

Make Clear Follow-Up Recommendations

• Use clear, concise language so the ordering practitioner can easily understand and act on the report.
• Include specific follow-up recommendations in the report. 
  • Clearly state the type of additional imaging or tests required and provide a suggested timeline for these evaluations.

 

Ensure Patient Awareness 

• Ensure closed-loop communication, which means the referring practitioner both informs the patient of the critical finding and discusses necessary follow-up steps with them.
  • Develop a process to ensure that practitioners both inform patients of incidental findings and provide follow-up instructions.
• Use plain language in the radiology report to ensure that patients who access the report through a patient portal can understand it. 

 

Involve Relevant Specialists

• Recommend a referral to the appropriate specialist if the incidental finding is outside your area of expertise to ensure the patient gets a thorough and expert evaluation.

 

Coordinate With the Care Team

• Inform all care team members about the incidental finding and any follow-up recommendations to ensure incidental findings are integrated into the patient's overall treatment plan.
• Define responsibility for incidental findings.
  • Avoid diffusion of responsibility for communicating incidental findings by identifying who is responsible at every stage.
  • Recognize that a radiologist and another practitioner may divide the interpretation of a diagnostic imaging study as part of a “split interpretation.”
  • Determine which practitioner will act on the finding.

Coverys Resources

• Communication-Related Error Strategies
• Improving Healthcare Literacy Through Plain Language
• Red Signal Report - Radiology

Additional Resources

• American College of Radiology (ACR), ACR Practice Parameter for Radiologist Coverage of Imaging Performed in Hospital Emergency Departments