Background:
Incidental pulmonary nodules are prevalent in hospital medicine, and many require follow-up imaging to exclude lung cancer. The Fleischner Society Guidelines were developed to guide practitioners in their management of these nodules. The purpose of this study was to understand the practices of hospitalist physicians nationally regarding the management of incidental pulmonary nodules, including hospitalists’ familiarity with the Fleischner guidelines.
Methods:
We developed a 14-item survey to assess practitioners’ exposure to and management strategies for incidental pulmonary nodules, including familiarity with the Fleischner Society Guidelines, and the presence and desire for automated tracking programs for incidental pulmonary nodules. Demographic information including members’ role in patient care, years of experience, and practice setting was also obtained. The survey was directed to SHM members through in-person kiosks at the 2016 annual SHM conference followed by two emails targeting 2016 SHM annual meeting attendees. Institutional review board exemption was granted.
Results:
We received 174 responses from a total of 3915 annual meeting attendees. Seventy-nine percent considered themselves hospitalist physicians, and 7% were advanced practice providers. Forty-nine percent practiced at a university or teaching hospital, 62% supervised trainees, and 63% were more than 5 years into practice. All respondents reported exposure to ≥ 1 patient with an incidental pulmonary nodule in the past six months, with 39% seeing 3-5 cases, and 39% seeing 6 or more cases. Despite this exposure, 42% were unfamiliar with the Fleischner Society Guidelines. When determining the need for follow up of an incidental pulmonary nodule, 83% utilized radiologist recommendations, 64% consulted national/international guidelines, and 35% spoke to a radiologist directly. Thirty-four percent agreed or strongly agreed that determining the need for follow-up was challenging, with 39% citing patient factors as the reason and 30% citing the scheduling of follow-up imaging as challenging. Only 15% of respondents reported the availability of an automated tracking system in their institution, although 64% desired automatic notifications of concerning results requiring follow-up.
Conclusions:
Despite frequent exposure to incidental pulmonary nodules, many hospitalist providers are unaware of the Fleischner Society Guidelines, rely on radiologists’ recommendations for follow-up, and infrequently have access to automated systems to assist providers in the identification and management of incidental pulmonary nodules, despite a desire for such systems. The follow-up of incidental pulmonary nodules is a prime target for hospital medicine quality improvement efforts.