67-year-old female, being surveilled by Vascular Surgery every 6 months for 5.0 cm AAA. Patient presented with acute limb ischemia and underwent BKA. During her post operative visit for the BKA, the patient was instructed to follow up as needed and did not return. 1.5 years later, our software was installed and identified the 5.0 cm AAA from the last surveillance study. The patient was contacted to return for surveillance imaging. Follow up CT described a 6.3 cm AAA and the patient is scheduled for endovascular repair.
84-year-old underwent an outpatient MRI of right hip preoperatively, for a Tenex procedure. The radiologist described a 5.7 cm AAA. Our software identified this patient in real time and presented the patient to the nurse navigator who was able to call the patient and PCP the same day. The patient was referred to Vascular Surgery and was evaluated within 2 weeks. He is now scheduled for an endovascular repair.
70-year-old male underwent abdominal CT for diverticulitis in 2018, this revealed a 4.2 cm AAA. No one was made aware of the incidental AAA. Our software identified the AAA in historical review of EMR. Patient and PCP were contacted, Vascular Surgery referral was made. The follow up surveillance US described 4.6 cm AAA and 2.8 cm common iliac artery aneurysm and now patient is now being routinely monitored.
We found several patients who were being monitored however, the ordered studies were not being performed. This unveiled a system issue with how orders were placed and defaulted to be routed to the incorrect scheduling department. After further discission with the clinic staff, this was a known issue but because we were able to demonstrate the frequency in which it was occurring, the clinic staff was able to escalate the problem with IT for correction.
As a nurse navigator, I have been able to contact patients who had no knowledge of their AAA. I’ve received many “thank you, I’m glad you called,” responses from patients. This interaction has given me the opportunity to educate patients on their diagnosis and help prevent them from getting lost.
I was able to use my clinical judgement and escalate a concern I had on a patient with our program’s medical director. Illuminate’s software identified a thoracic aortic aneurysm from a chest CT, the patient’s upper abdominal aorta was partially visualized and mentioned dilatation. After further review, the patient never had abdominal imaging. Not only were we able to get the patient in for surveillance imaging of the chest, we also obtain abdominal imaging which revealed a large infrarenal AAA.
Steven Okuhn, MD
Vascular Surgeon – Kaiser Permanente®
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