Abstract

Background
Abnormal chest radiographs performed during acute hospital admissions frequently require repeat imaging to confirm resolution and exclude underlying malignancy. BTS guidance recommends timely follow-up chest radiography, particularly following pneumonia or indeterminate radiographic abnormalities. Failure to complete follow-up imaging may delay diagnosis of significant underlying pathology. We audited compliance with Safety-Net follow-up processes within Salford Royal Foundation Trust.
Methods
A retrospective audit was undertaken of patients entered into the Safety-Net chest radiograph follow-up pathway. Data were collected from electronic records, radiology reports and follow-up correspondence. Variables recorded included patient demographics, initial chest imaging findings, timing of repeat imaging, radiological outcomes, CT thorax utilisation and compliance with recommended follow-up intervals. Follow-up chest radiographs performed within 70 days (10 weeks) of the index study were classified as on time.
Results
A total of 55 patients were included in the audit. Follow-up chest imaging was completed in 43/55 patients (78.2%), while 12/55 patients (21.8%) had no documented follow-up imaging and were considered missed follow-ups. Thirty-two patients (58.2%) underwent follow-up chest radiography within the recommended timeframe, while 11 patients (20.0%) had delayed imaging. The median time to first follow-up chest radiograph was 42 days (mean 70.6 days). CT chest imaging was performed or highlighted as part of further investigation in 50/55 patients (90.9%). Radiological outcomes demonstrated complete resolution or reassuring interval improvement in 24 patients (43.6%), persistent abnormalities requiring ongoing surveillance in 6 patients (10.9%), indeterminate findings in 13 patients (23.6%), and no outcome available in 12 patients (21.8%) due to absent follow-up imaging.
Conclusions
Most patients received follow-up imaging after identification of an abnormal chest radiograph; however, over one-fifth of patients had no documented follow-up, representing a potential patient safety concern. While compliance with recommended follow-up intervals was acceptable in those completing imaging, missed and delayed follow-up remains an important quality-improvement target. Enhanced tracking systems, automated alerts and dedicated Safety-Net governance processes may improve adherence to follow-up recommendations and reduce the risk of delayed diagnosis.