Michael Tse-Yin Lu MD, Presenter: Nothing to Disclose

David Andrew Rosman MD, Abstract Co-Author: Advisory Board, UnitedHealth Group

Carol C. Wu MD, Abstract Co-Author: Author, Amirsys, Inc

Tarik K. Alkasab MD, PhD, Abstract Co-Author: Nothing to Disclose

Jo-Anne O. Shepard MD, Abstract Co-Author: Consultant, Agfa-Gevaert Group

Giles W. Boland MD, Abstract Co-Author: Nothing to Disclose

Matthew David Gilman MD, Abstract Co-Author: Nothing to Disclose

The indeterminate pulmonary nodule is a common incidental finding on abdominal CT. While the abdominal radiologist plays a critical role in recommending appropriate follow-up, we have previously demonstrated that the majority of recommendations deviate from best practice guidelines. We implemented an automated decision support tool to provide evidence- and consensus-based recommendations at the point-of-care for further imaging based upon the Fleischner Society guidelines. The goal of this study was to evaluate the effect of the CDS tool on adherence to guidelines for follow-up of incidental pulmonary nodules.

The RIS was mined for abdominal CT reports from 10/22/12 – 4/4/13 with a solid, noncalcified, pulmonary nodule that did not have a prior abdominal CT or prior or concurrent chest CT. History of smoking or malignancy, whether follow-up chest CT was recommended, and the time interval for follow-up were recorded. Concordance between the radiologist’s recommendation for follow-up and departmental guidelines was compared between three groups: reports where the CDS tool was used, those where it was not used, and 268 historical controls prior to the implementation of the CDS tool.

Out of 7,713 consecutive abdominal CT reports, 243 described a pulmonary nodule. Manual review of these reports yielded 141 consecutive patients who met inclusion criteria. The CDS tool was used in 40% (57/141). When used, 95% (54/57) of the recommendations were concordant with guidelines. In the remaining 5% of cases (3/57), the radiologist overrode the CDS tool and recommended more aggressive follow-up. Concordance with guidelines was significantly greater for the CDS group than the non-CDS group (45%, 38/84, p < 0.01) and historical pre-intervention controls (50%, 133/268, p < 0.01).

A point-of-care CDS tool improved adherence to departmental guidelines for follow-up of incidentally detected pulmonary nodules.

Real time, point-of-care CDS tools can decrease the variability of radiologist recommendations, which may impact patient outcomes and cost.

Lu, M, Rosman, D, Wu, C, Alkasab, T, Shepard, J, Boland, G, Gilman, M, Impact of a Point-of-Care Electronic Clinical Decision Support (CDS) Tool on Adherence to Departmental Guidelines for Follow-up of Incidental Pulmonary Nodules on Abdominal CT.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13014202.html