Section 11: Transitions of Care
Pulmonary Nodules and “The Beast”
Effective tracking and consistent follow-up on lung nodules and pathology results, including biopsy specimens, are vital components of quality patient care within our institution. Frequent staff turnover and varying rotations necessitate a standardized, reliable tracking system. Nodule tracking ensures continuous monitoring and care, while pathology tracking provides essential diagnostic and treatment-planning data. Robust tracking and diligent follow-up uphold patient-care standards and prevent oversights during personnel transitions.
NMCSD Pulmonary Clinic Nodule Tracking Standard Operating Procedure (SOP):
Pulmonary Nodule Tracking is coordinated by Charlaine Clayton using GENESIS messaging. “The Beast,” an Access database, primarily handles procedural and pathology tracking but still supports nodule management tasks.
Nodule Tracker/BEAST Overview:
The Beast primarily functions to:
- Track department procedures conducted at NMCSD in various clinical settings.
- Track procedural pathology results for patient follow-up and care continuity.
Rules of The Beast:
- Only one instance of The Beast can be open at a time; close promptly after updates.
- Do not update if errors or warnings appear; wait and retry later.
- Always use the latest backup version.
- Enter imaging follow-up dates as the first of the target month to streamline tracking.
Accessing The Beast:
Access The Beast via the share drive in the Pulmonary Department folder. CAC certificates must be added by Dr. Biberston for new users.
Nodule/Imaging Tracker User Roles:
Fellows Responsibilities:
- Enter procedures into The Beast.
- Discuss pending pathology at Friday Conference and log completion.
Staff Physicians Responsibilities:
- Oversee Friday pathology reviews and determine follow-up imaging intervals when primary providers are unavailable.
Nodule Coordinators Responsibilities (managed by Charlaine Clayton):
- Generate monthly imaging lists and patient messages.
- Ensure imaging is ordered/completed and notify providers.
- Enter recommendations into The Beast and triage patient-contact issues.
Clinic Corpsmen Responsibilities:
- Contact patients for repeat imaging.
- Update message status based on contact outcome.
- Escalate unresolved issues to Nodule Coordinators.
Adding patients for future imaging:
To add a patient for future imaging:
- Send a GENESIS message labeled “Z. New Patient Who Requires Future Imaging Follow-up.” (The “Z.” prefix separates new-patient entries from routine tracking.)
- Specify imaging month/year, imaging type, reason, and order status.
- Nodule Coordinators will add the patient to the tracking cycle.
Procedural Pathology Tracking SOP
All procedures performed by the Pulmonary Department should be entered into The Beast for tracking. This serves several purposes:
- Tracking procedural numbers for graduation requirements and future verification of competencies.
- Tracking pending pathology to ensure workups are advanced and actioned appropriately.
***Our Program Goal is to review pending Beast Pathology every Friday after conference***
To add a procedure, you must:
- Ensure you open the most recent copy of The Beast (the most current, last-saved date).
- Add the patient to The Beast using the “Add Patient” button.
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Then use the “Add Procedure” button to add the procedure.
- If the primary procedure is an EBUS, you may also select BAL and TBNA as associated procedures.
- For pathology, select “Pending.” Once results are available, reopen the patient’s Beast entry and update the pathology to reflect final results.
Save The Beast after updating and close it as soon as possible.
Consult Turnover
Turnover between consult fellows represents a large and important transition of care within the fellowship and is a potential vulnerability in terms of losing track of clinical information. All hand-offs must adhere to the principles outlined in the “NMCSD GRADUATE MEDICAL EXECUTIVE COMMITTEE (GMEC) Policy: Transitions of Care”. This includes utilizing standardized processes and ensuring complete and accurate clinical information transfer to maintain patient safety and continuity of care. Programs are required to ensure residents utilize a standardized process/template for change of duty hand-offs, such as IPASS or SBAR, especially for transfers between services and locations. The following program-specific procedure is designed to meet these requirements for consult fellow turnover.
Weekly Staff Turnover:
During the rotation, turnover occurs weekly with the fellow, off-going staff, and oncoming staff—this happens after the pending pathology review at Friday Conference. It should include a brief discussion of all active inpatients and outpatients who have ongoing needs for the following week, including procedures scheduled.
Fellow Monthly Turnover:
Off-going consult fellow sends the following information via encrypted email to:
- The oncoming consult fellow
- Both the off-going and oncoming consult attendings
Be sure The Beast is updated with pending pathologies before turnover.
References and Appendices
Section 11 Appendix 1: NMCSD GRADUATE MEDICAL EXECUTIVE COMMITTEE (GMEC) Policy: Transitions of Care (07 April 2025)