Objective: To ensure appropriate follow-up for the multiple incidental pulmonary nodules found on imaging studies.
Materials and Methods: A lung nurse navigator program was established at Middlesex Hospital in 2005. Part of the navigator’s role was to implement surveillance on lung nodules found through computed tomography (CT). The program was instigated because radiologists expressed concern that not all abnormal findings reported were receiving the recommended follow-up.1 The nurse navigator and a radiologist met to plan a process through which all abnormal findings would be tracked and followed. From this, they developed a database accessible to both the radiologist and the nurse navigator, which ensures appropriate follow-up in collaboration with the primary care physician. Fleischner Society guidelines were implemented for all identified lung nodules, and pulmonary consults were offered as appropriate. Fleischner Society guidelines were established to provide recommendations for follow-up and management of nodules smaller than 8 mm detected incidentally at nonscreening CT.2
Results: The collaboration of the lung nurse navigator, radiology physicians, pulmonologists, and the emergency department physicians has increased the number of patients referred to the lung surveillance program at our institution by 75% overall. The quality-assurance program was started in June 2010, and more than 500 patients have been screened through the program. If further surveillance is warranted, patients are placed on the surveillance portion of the lung program. In January 2010, before the initiation of the quality-assurance program, there were only 7 patients on the surveillance portion of the lung program. This number increased to 37 patients in January 2011, an increase of 82%. This quality-assurance program has been used by 100% of the radiologists. The program has not only increased the number of referrals to the lung program, both for surveillance and for the lung cancer portion of the program, but also has created an increased collaboration among the nurse navigator and the physicians in the community, as evidenced by the increase in the number of calls from primary care physicians to the lung nurse navigator.
Conclusions: Nurse navigators can play an important role in lung nodule surveillance, which benefits the patients as well as the physicians. The recommendation for follow-up of pulmonary nodules has been set by the American College of Chest Physicians3; but uniform follow-up is not always the case. Primary care physicians look for guidance from radiologists as to the recommended follow-up of abnormalities. Likewise, emergency department physicians, upon finding incidental nodules, are looking for a system in which follow-up is ensured. The quality-assurance program at Middlesex Hospital, led by the lung nurse navigator, provides this vital service.
- Godoy MC, Naidich DP. Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology. 2009;253:606-622.
- MacMahon H, Austin J, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleishner Society. Radiology. 2005;237:395-400.
- Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007;132(3 suppl):108S-130S.