This month’s blog is written by APAPP member Kati Foechterle, Nurse Practitioner working out of Pueblo, Colorado in a private practice. Her Master’s Degree is in Adult/Gerontology Acute Care and Family Practice but has been working in Pulmonary Medicine since 2014. Outside of raising her 2-year-old and 11-month-old children, in the Fall she will start pursuing her Doctorate in Nursing.
Nodules, Nodules Everywhere
By Kati Foechterle, APRN
My pulmonary clinic is a private clinic with 4 physicians and myself. We are located in Pueblo, CO and have 2 associated hospitals and a fellowship program consisting of 9 physicians. Our pulmonary nodule clinic was initially started out of our local hospital system with an NP navigator. The process of referral to the nodule clinic starts with our hospital and local radiologists. Once a nodule is identified on inpatient or outpatient scans, the radiologist tag the exam and consult the navigator. The navigator is responsible for checking other hospital systems and radiology groups for comparison CTs as well as reviewing the images and consulting physicians in their practice to develop a plan of care. If the patient was actively admitted at the time of referral, the navigator would see them, go over results and the plan of care while in house, and set a follow up with our outpatient clinic. If biopsy was recommended during review process, it would be set up and completed before the patient is discharged. Outpatient follow up is then scheduled 3-5 days later to go over findings. Nodules found in the outpatient setting, radiology departments were asked to add a disclaimer to the bottom of the report that recommended follow up with the nodule clinic and listed our phone number. This seemed to make us more accessible to the ordering providers.
Priority scheduling of these patients is mandatory. We all know when a patient Googles pulmonary nodules, they come away thinking they are dying of cancer even though we know statistically most nodules are benign. Our practice sees all new nodule patients within 1 week no matter the size. We feel seeing these patients promptly helps with patient anxiety and accelerates the process if it truly is a concerning lesion. We also have a process for notifying PCP offices if a patient does not follow through with the surveillance plan.
Our navigator experience has provided patients with a better understanding of what a nodule is and explanation of the guidelines used to follow them. Navigation is an integral part of helping us catch incidental nodules, investigate old imaging to prevent redundant or excessive scans, and they aid in patients following up through 12-24 months of surveillance.
What we have learned from starting this whole process is that if you want to get a nodule clinic running you not only need a navigator you also need to make the radiologist your best friends. Really, the biggest buy in needed is from radiology. They are the 1st line in identifying nodules and what they recommend in their reports and where they send the results are crucial.