Or, the medical resident who ordered the scan originally might have finished his or her rotation in the hospital by the time the scan results came back, and the resident's replacement might not immediately process the report. Or, they say, the report might just simply get lost in the "crush of clinical information" that bombards physicians each day.
That's why the automated coding and reporting system developed at the Ann Arbor VA could be so useful in any hospital, Marn explains. The rapid increase in medical imaging in recent years, combined with the increased use of computerized medical records systems and digital medical-image systems called PACS, means the time is right to use digital technology to keep patients from falling through the cracks.
Missed follow-up on cancer scans is just one example of a patient-safety issue that stems from inadequate communication, incomplete handoffs between professionals and systemic "holes" that patients can slip through, Marn adds.
The researchers also collected data on patients with "Code 4" tags on their medical images, meaning that the radiologist had spotted something on the scan that wasn't cancer but might indicate another problem. They are now analyzing data from those patients.
Importantly, Marn says, the new paper also shows that no patients whose medical-imaging scans were ordered by emergency or urgent-care doctors fell through the cracks. However, the study was not able to determine if there were any differences in follow-up care between residents and attending physicians, or residents at different stages of their training.