Incidental pulmonary nodules; eliminating the risk of missing early lung cancer

<bold>Introduction:</bold> Managing incidental pulmonary nodules (IPNs) requires dedicated resources to ensure early lung cancers are identified. In 2022 we developed a bespoke IPN service, with part of its aim being to assess how many IPNs were not referred and or managed as per the BTS Pulmonary Nodule Guidelines. <bold>Methods:</bold> We audited our radiology workflow system (CRIS) to identify patients between January 2018 and October 2022 who should have been referred to the IPN service. It was felt that a patient would have presented acutely or have been diagnosed with malignancy if they had a clinical significant IPN identified prior to 2018. <bold>Results:</bold> 705 patients were identified, with their records being reviewed and classified into the categories detailed in Table 1. This allowed us to prioritise their management accordingly and apply duty of candour. We identified 2 patients with a missed lung cancer or who had died as a direct result of not being referred to our service. The four main clinical areas where patients were not referred from included Surgical Specialties (n=42); Emergency Medicine (n=38); Acute and general medicine (n=18) and Cardiology (n=16). <bold>Conclusions:</bold> We have now been able to determine the extent of how many IPNs were not managed appropriately prior to setting up our service. Consequently, we are now proactively auditing CRIS monthly to ensure patients are appropriately referred. We also have developed an electronic internal referral proforma directly to the service. Referrals to our service will be audited quarterly to ensure improvements in patient safety and will be shared with our trust’s clinical governance.