September 10, 2020

Emergency Medicine and Radiology Care Coordination Initiative

Studies show that 2–10% of radiology reports include recommendations for follow-up imaging associated with incidentally detected abnormal imaging results. However, despite the likelihood that follow-up imaging will reveal clinically significant findings, compliance with recommended follow-up only ranges from 29–77%.

To address that challenge, the ACR® and the American College of Emergency Physicians (ACEP) have embarked on a collaborative Care Coordination Initiative to identify opportunities for improved care coordination between radiology and emergency medicine services related to non-emergent incidental findings.

The first effort of the ACR-ACEP work group will be to produce a white paper on the follow-up of recommended imaging for incidental findings focused on:

  • The current state to include a variety of clinical scenarios.
  • The ideal state.
  • Barriers to achieving the ideal state.
  • Current strategies to overcome barriers and ensure closing the loop occurs.
  • Future promising opportunities.

Q&A With ACR Co-Chair

Gregory N. Nicola, MD, FACR, Vice President of the Hackensack Radiology Group, is ACR Co-Chair for the ACR-ACEP Care Coordination initiative. He recently answered a few questions about the significance of the project and the white paper.

Q. Why is the follow up of incidental findings an especially important care coordination topic for radiology and emergency medicine?

A. Incidental findings are difficult to manage because, in many ways, we are trying to manage something we are uncertain about the consequences of not following. We have reasonable evidence and expert opinion regarding management of a subset of incidental findings, but the broader uncertainty leads to confusion amongst patients and referring doctors. In the emergency room setting, the doctor-patient relationship is less established, heightening confusion and leading to potential missed care opportunities

Q. What should be the scope of the paper with regard to the various practice types and settings — is it equally important across all?

A. The writers of the white paper are very aware that a “one-size-fits-all” attitude will not be effective for moving the needle on closing this care gap. We must present a diverse set of simple-to-implement options in order to match the great diversity of practices our organizations represent.

Q. What is one thing you most hope will result by championing this project?

A. I hope as radiologists and emergency physicians, we see what teamwork can bring to the table in providing better care for our patients. Care gaps exist because of murky accountability, and this project’s goals will hopefully establish that accountability can often be a team effort.

Q. Where can people learn more about this initiative?

A. Watch for more information about the ACEP-ACR Care Coordination Initiative and white paper in future issues of the Inside Quality & Safety newsletter.