There have been numerous articles about the need for physicians to follow up when there are lab results or radiology reports indicating serious conditions. The articles stress that each medical facility must have protocols or procedures to ensure that such results do not “fall between the cracks.”

One example is a radiology report that identifies a lung nodule that could be cancerous. The imaging may have been ordered for some other reason, like chest pain, so the report may be reassuring about that condition while also noting the lung nodule finding.

If the patient is being discharged, or was seen on an outpatient basis, it is imperative that the discharge personnel discuss the finding with the patient, and also note in the chart that this was done. Further, the patient should be told to follow up with his primary care physician.

In addition, the information must be sent directly to the patient’s regular physician with specific mention made of the findings and the need to follow up. Some experts suggest that the discharging personnel also have a duty to directly contact the patient’s physician to be sure the information was received and that action is being taken.

A recent case involved a key CT scan to screen for a possible brain aneurysm in a patient who had a strong family history of such abnormalities. The report, which indicated a possible aneurysm, was received when the primary care physician was on vacation, and the physician’s assistant did not take immediate action to discuss the finding with the patient. She did order an MRI, which was reassuring.

By the time the physician was back at work, no one followed up on the abnormal finding on the CT scan or the discrepancy between the two reports. Two years later the aneurysm ruptured. Some experts suggest that radiologists have an independent duty to follow up on findings that could result in risk to the patient, especially if the risk is imminent. The American College of Radiology has guidelines for situations where an acute finding requires immediate notification of the physician who ordered the imaging study.

This problem is most acute in the emergency room setting. Patients may be seen for relatively short periods of time, so a key lab result or radiology report may be received after the patient has been sent home. And because the ER physicians are working in shifts, the next shift physician may receive the actual report or lab result but not be on top of the condition for which the test or imaging was ordered.

Experts say that any protocol for follow up must prioritize the seriousness of the condition. Some findings, such as an intracerebral hemorrhage, require a “red alert,” meaning notification and follow up within 60 minutes. “Orange alerts” may be used for conditions that must be addressed within 2-3 days. Finally, “yellow alerts” may be appropriate for conditions, such as a lung nodule, that do not require immediate action but that could result in significant morbidity if not addressed in the near future.

Given the complexity of current medical care, and the number of people that may be involved in the care of a single patient during a clinic or hospital visit, formulating effective protocols can be a daunting task. This and other patient-safety tips can be found at www.patientsafetysolutions.com.