Incidental Findings in Trauma Patients: Dedicated Communication with the Primary Care Physician Ensures Adequate Follow-Up

• Published in: World journal of surgery Vol. 37; no. 9; pp. 2081 - 2085
• Main Authors: Yeh, D. Dante, Imam, Ayesha M., Truong, Shani H., McLaughlin, Erin L., Klein, Eric N., Avery, Laura L., Velmahos, George C.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Cardiac Surgery; Communication; Continuity of Patient Care; Discharge Summary; Female; General Surgery; Humans; Incidental Findings; Male; Medicine; Medicine & Public Health; Middle Aged; Physician-Patient Relations; Physicians, Primary Care; Primary Care Physician; Primary Care Physician Visit; Surgery; Thoracic Surgery; Thyroid Nodule; Trauma Patient; Vascular Surgery; Wounds and Injuries - epidemiology; Wounds and Injuries - surgery; Trauma Patient; Primary Care Physician Visit; Discharge Summary; Thyroid Nodule; Primary Care Physician
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-2092-8

Background
Frequent use of computed tomography (CT) in trauma patients results in frequent detection of non-trauma-related incidental findings (IFs). Inpatient documentation and disclosure at discharge are infrequent, even when they are potentially serious. We aimed to not only identify the incidence of IFs but also to evaluate the effectiveness of an intervention to trigger follow-up.
Methods
In this before–after study, all trauma patients evaluated by the trauma surgery service who underwent CT were admitted for >24 h, had at least one IF requiring follow-up, and had a primary care physician (PCP) employed in our health care system were identified. The historical control period was from January 2006 to December 2008. The intervention period was from December 2011 to September 2012. Intervention consisted of notifying the PCP via email or postal letter. The outcome of interest—the rate of follow-up—was compared between both groups.
Results
During the historical period, 364 (20.5 %) of 1,774 eligible trauma patients had 434 IFs requiring follow-up. During the study period, 197 (26 %) of 692 trauma patients had 212 IFs requiring follow-up. Overall, 91 % of study patients with postdischarge PCP follow-up had documented follow-up of the IF. There was a significant improvement in the rate of follow-up in the study group compared to that of the control group (51 vs. 11 %;
p
 < 0.0001).
Conclusions
Detection of IFs is common in trauma patients. A dedicated effort of communicating the presence of an IF to the patient’s PCP triggered a follow-up for 91 % of patients who saw their PCP after hospital discharge.