Background and objectives With increasing use and fidelity of CT scans the workload relating to surveillance of indeterminate lung nodules is ever increasing and is burdensome in terms of out-patients appointments and/or clinical administrative time. In July 2014 we established a ‘virtual nodule clinic’ (VNC) for reviewing indeterminate lung nodules. A proforma within our hospital electronic patient record is completed which automatically generates written communication for both the patient and the GP informing of the findings of the latest CT result and any follow-up required. The patients are not seen in clinic unless they request. The clinic template allows review of 40 cases per session.
The objectives of this study are to review the impact of the VNC on concordance with Fleischner guidelines and timeliness of communication of results.
Methods We retrospectively reviewed 50 consecutive nodule follow-up scans performed in November 2013 prior to establishment of VNC and 49 consecutive cases reviewed in VNC in November 2014. Concordance with Fleischner guidelines and date from CT scan to patient/GP being informed was reviewed.
Results Demographics were similar between groups.
The VNC has improved concordance with Fleischner guidelines in lung nodule surveillance by 40%. Prior to the VNC, 52% of patients had surveillance concordant with Fleischner guidelines. Following the introduction of the VNC, 92% of patients had follow-up concordant with Fleischner guidelines.
Median time from the date of CT scan to the patient/GP being informed of CT results was 5 weeks. None of the cases reviewed in VNC contacted us to request a face to face consultation despite this being offered within the written communication to patients.
Conclusion The introduction of a virtual nodule clinic has significantly improved concordance with published guidelines for radiological follow-up of indeterminate lung nodules. It has also allowed a significant reduction in the number of ‘unnecessary’ out-patient appointments within the lung cancer service. VNC ensures effective and timely communication of scan results to patients and GPs.
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