The following is a summary of “Value of Using a Quality Assurance Follow-Up Team to Address Incidental Findings After Emergency Department or Urgent Care Discharge: A Cost Analysis,” published in the December 2023 issue of Emergency Medicine by Blodgett, et al.

The follow-up associated with incidental findings (IF) is of utmost significance for the safety of patients and is a potential source of malpractice risk. When laboratory, imaging, or other forms of IFs are discovered by accident, they are often overlooked, not addressed, or only become apparent after the patient has been discharged. Even though there is a growing body of research on IF notification, there is a need to investigate cost-effective solutions that are not exclusive to electronic health records (EHRs) and that can be used across various IFs and EHR versions. For a study, researchers sought to assess the usefulness and cost-effectiveness of an electronic health record (EHR)-independent quality assurance (QA) follow-up program for emergency medicine. 

The program consisted of an experienced nurse reviewing laboratory and imaging data and ensuring appropriate follow-up of findings. A quality assurance nurse evaluated abnormal studies from the previous day. These tests were from a community hospital, an urgent care center, and a tertiary care hospital. Laboratory readings outside the established ranges or radiography over-reads that resulted in clinically relevant alterations prompted contact with an emergency physician on call to decide on a suitable intervention and its execution.

Of the 104,125 visits, there were 1,351,212 laboratory tests and 95,000 imaging studies. Of those visits, there were 6,530 that had IFs, which included 2,659 laboratory results and 4,004 imaging findings. The intervention carried out the most often was contacting a primary care physician (5,783 instances, or 88.6%). In twenty-one instances, a patient was brought back to the emergency department, and the average cost of a potentially life-saving or limb-saving intervention was $28,000. A dedicated quality assurance follow-up program in the emergency department led to the identification and communication of numerous laboratory and imaging abnormalities. These abnormalities may change patients’ subsequent clinical course, potentially increasing patient safety. Even though abnormalities in laboratory results and imaging are frequently incidental to patient care, the program was successful in identifying and communicating these abnormalities.

Source: .sciencedirect.com/science/article/abs/pii/S0736467923004298