Radiologist review at the time of lung nodule referrals saves clinic appointments and fast tracks investigations: results of the outpatient respiratory nodule management (Ornament) study.

backgroundWith increased awareness around the National Lung Cancer Screening Program (NLCSP), there are increased general practitioner (GP) referrals to outpatient clinics for evaluation of incidental computed tomography (CT)-detected lung nodules (ILNs). We studied how expert radiologist review of the referral chest CT could mitigate clinic numbers and expedite urgent cases.

methodAn Ethics Committee-approved 'virtual triaging' of referrals was performed. The radiologist reviewed referral CT scans, blinded to the clinic outcomes. Brock score was calculated before and after radiologist review, and the NLCSP category was assigned to allow 'virtual' triaging. NLCSP Category 1-4 cases were 'virtually' referred back to the GP. Category 5 and 6 cases were triaged for clinic/procedure as urgent/very urgent respectively.

resultsFrom 6 months of referrals, 101 consecutive cases were reviewed in four half-hour meetings with a radiologist, thoracic physician and clinic nurse. Referrals were 52 males and 49 females, the mean age was 67.0 ± 12.0 years, and the mean Brock score was 13.9 ± 13.8. Fifty-four cases (53%) were deemed Category 1-4, needing no appointment. Thirty-three cases were deemed suspicious of lung cancer (NLCSP Category 6), resulting in early 'virtual' appointments saving 37.3 ± 28 days wait time (range 0-89 days). Comparing actual to virtual, clinic numbers saved were 131 (336 vs 205, P < 0.001) and clinic preparation hours saved were 83.4 (170.5 vs 87.1, P < 0.001). Meeting costs including CT retrieval time (AU$2171) were balanced by savings from reduced clinic preparation time (AU$3582).

conclusionThis cost-effective strategy demonstrates dual benefits of managing rising referral numbers and fast-tracking urgent cases for procedures.