Asymptomatic Abdominal Aortic Aneurysm: Standardizing Reporting Recommendations at a Large Multistate Radiology Practice
J Am Coll Radiol . 2021 May 10;S1546-1440(21)00326-4. doi: 10.1016/j.jacr.2021.04.009. Online ahead of print.
Sameer Ahmed, Jason Mitsky, Upma Rawal, Sheila Sheth, Jay Bronner
Objective: Although often asymptomatic at initial diagnosis, abdominal aortic aneurysms (AAA) require careful surveillance to prevent rupture, with rupture-associated mortality rates as high as 90%. The purpose of this study was to explore if a performance improvement initiative implemented across a large radiology practice successfully increased inclusion of best practice recommendations (BPRs) within the radiology report across the practice.
Methods: After BPR for asymptomatic AAA surveillance was developed, a structured reporting macro for follow-up recommendation was integrated into dictation software. After a training period, inclusion of recommendations within the radiology report was monitored across 345 facilities within the practice. Performance was reported on scorecards distributed monthly. To measure practice improvement, inclusion of appropriate recommendation in radiology reports postimplementation was compared with pre-implementation data.
Results: During the period before AAA BPR implementation, from 64,090 consecutive cross-sectional radiology reports reviewed during a 6-month period, 855 incidental AAAs (1.3%) were identified, with 783 aneurysms measuring 2.6 to 5.4 cm requiring imaging surveillance; only 17 (2.1%) included follow-up recommendations within the radiology report. Postimplementation, 2,641 of 148,807 cross-sectional imaging studies were positive for 2.6- to 5.4-cm AAAs requiring further management; 1,533 (58.0%) of these radiology reports included follow-up imaging recommendations (97.0% of which followed our AAA BPR).
Discussion: Quality improvement initiatives to develop BPRs for AAA surveillance and include these recommendations within the radiology report can be successfully implemented across large practices and are imperative to ensure imaging surveillance and avert AAA rupture.
Read Full Article Here: https://doi.org/10.1016/j.jacr.2021.04.009