As technological advancements improve diagnostic imaging and testing, the number of incidental findings increases. This results in both positive and negative consequences for patients and healthcare providers. It also provides an opportunity for advanced practice registered nurses (APRNs) with a Doctor of Nursing Practice degree to use their unique skills and work to their full scope of practice.
What Are “Incidental Findings”?
Incidental findings (also referred to as incidentalomas) are unexpected findings discovered when a patient undergoes medical testing or assessment for another medical problem or concern. They may be found “during routine workup, diagnostic imaging, and frequently, in emergency situations in which imaging is done after a traumatic event.”
How Do Incidental Findings Pose a Threat to Healthcare and Patients?
Incidentalomas increase the complexity of patient care and may result in both positive and negative consequences for patients and the healthcare system. On the positive side, these findings sometimes uncover real health problems such as cancer or other life-threatening conditions allowing early treatment that saves a patient’s life.
However, incidental findings are often not life-threatening, resulting in unnecessary biopsies, medical tests and follow-up appointments. In addition, a recent study of almost 400 internal medicine physicians across the U.S. found “that pursuing incidental findings caused their patients psychological harm (68%), physical harm (16%), and financial burden (58%) — and also caused the patients wasted time and effort (69%), frustration (53%), and anxiety (45%).”
What Challenges Do Hospitals Face With Incidental Findings?
Incidental findings also create a significant challenge for hospitals and physicians. In the same study, 22% of physicians reported spending time weekly calling patients to follow up and ordering tests for these findings, which resulted in significant lost physician time.
Another problem is that it is often unclear who’s responsible for following up with the patient regarding incidental findings. This is particularly true if a patient comes into the emergency department (ED) due to trauma. If the ED physician orders tests and discovers the finding, the physician will usually convey the information to a specialist or the patient’s primary care provider, assuming the other physician will follow up with the patient. However, when more than one provider receives these results, follow-up may not happen, putting the patient at risk.
Why Are APRNs Ideal for Managing Incidental Findings?
Because of the risks associated with not following up on incidental findings, the added burden this responsibility puts on physicians, and the resulting confusion regarding whose responsibility it is to follow up, a designated incidental findings coordinator may be the solution. Not surprisingly, APRNs are ideal practitioners for this role.
An incidental findings coordinator would need to have “clinical expertise, the authority to place orders, patient counseling skills, and the ability to work inter-professionally.” APRNs have all these skills. Hiring an APRN in this role would also allow the nurse to work to their full scope of practice and help eliminate confusion regarding who needs to follow up with a patient.
In this role, APRNs can help reduce patient, hospital and healthcare costs while improving patient outcomes and safety.
As diagnostic imaging technology and medical testing improve, the number of incidental findings will increase. This results in unnecessary harm and financial losses for patients and the healthcare system. Compounding this problem is confusion regarding who should follow up on these findings with patients resulting in safety concerns. APRNs’ clinical and educational preparation combined with their communication skills and ability to work inter-professionally make these nurses ideal for filling the complex role of incidental findings coordinators in hospitals and diagnostic imaging centers.
Learn more about UTA’s Doctor of Nursing Practice online program.
Sources:
Harvard Health Publishing: What to do About Incidental Findings
