The following is a guest article by Justin Schrager, MD, Co-Founder and CMO at Vital
Picture a typical day in a busy emergency department, where about 100 patients come through the door. Statistically, one of these patients will leave the ED with an unaddressed but clinically urgent incidental finding — something found by the radiologist on an imaging study – that no one told them about.
An example might be a lung nodule found on an X-ray taken to evaluate a shoulder injury. And, because a lung nodule is not typically an emergency, but a shoulder dislocation almost always is, the nodule can “fly under the radar.” There are a variety of reasons why a patient might not be told about their lung nodule; these include everything from timing and complexity to pain level, mental and psychological readiness, or a simple oversight. In my clinical experience, this communication gap isn’t due to carelessness; it stems from the relentless pace of emergency medicine and a system that isn’t designed to catch everything.
Incidental findings are a routine byproduct of modern imaging, as are the frequent instances in which doctors in the hospital do not communicate these new findings to their patients. However, unlike other patient safety and care quality challenges (for example, preventing hospital acquired infections or falls), the disclosure of incidental findings and the subsequent care planning that needs to happen after the disclosure, span the inpatient-outpatient world and are therefore more vulnerable to the relatively archaic communication systems we use in healthcare: patient portals that not everyone uses, fax machines, delayed letters in the mail.
Unfortunately, incidental findings are not rare. In trauma patients receiving CT scans, incidental findings appear in roughly 30–35% of studies. Among all ER patients, approximately 1 in 12 will have a new finding they’ve never been told about. Of that group, a further one in twelve will go on to experience a clinically meaningful outcome — cancer within five years, a procedure they needed, a condition that could have been managed earlier.
The issue isn’t a lack of effort or intentionality — it’s infrastructure.
In the ER, physicians are necessarily focused on the acute problem that brought the patient in. Radiologists who identify incidental findings aren’t at the bedside. Hospitalists and other inpatient clinicians may be treating entirely different issues days or weeks later. Primary care physicians often lack an efficient way to review and act on results immediately after a hospitalization. And the patient—the most important stakeholder—is often too ill or not in the right frame of mind to track something that requires follow-up months later.
The result is a fragmented system with no reliable, scalable way to identify, track, and close the loop on these findings.
AI-powered tools are now changing that calculus. Purpose-built systems can continuously scan clinical notes, discharge paperwork, and radiology reports to identify findings that appear to have gone uncommunicated. When a gap is detected, it’s flagged for clinical review — surfacing the relevant context and making it easy to act quickly. A single clinician in a care coordination role can monitor findings across an entire facility, turning what would otherwise be a logistical nightmare into a manageable, auditable daily workflow.
When outreach is warranted, these systems give clinicians the flexibility to call patients directly or send a secure, personalized message — including plain-language educational content tailored to the specific finding. Every interaction is tracked, every touchpoint logged, and the status of each outreach is visible in real time.
Beyond the patient harm that goes unaddressed, the medico-legal exposure is significant. Missed incidental findings are among the most common sources of diagnostic error claims in emergency medicine.
Because of recent technological advancements, the infrastructure to close this care gap exists today. We no longer need to force clinical staff to sit on the phone for hours on end or pay third-party services exorbitant prices to do this for us. For health systems ready to take this step, the question is no longer whether to act — the ability to solve this problem (and many similar ones) is now more approachable, affordable, and actionable than ever. I also suspect that for health systems that take this initiative, there will be a true windfall manifested by improvements in system loyalty, market share, and patient experience.
Justin Schrager is an Emergency Medicine physician, Co-Founder, and Chief Medical Officer at Vital. He practices medicine while leading the development of AI-powered technology solutions to improve acute patient care. He is the author of 20+ papers on advancing AI in healthcare. His mission: use technology to improve the acute care experience for patients, families, and clinicians.
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