Approximately 50% of imaging exams include a finding that necessitates additional imaging, yet closure rates for recommended follow-ups can be as low as 30%. Recognizing this significant gap and the associated risks to care continuity, timely diagnosis, and patient outcomes, St. Tammany Health System (STHS) in Southern Louisiana prioritized establishing a high-reliability follow-up program focused on improving follow-up closure rates, the clarity and appropriateness of recommendations for additional imaging, and lowering task demands on staff.
STHS already had a strong and established Six Sigma process improvement foundation. They hypothesized that partnering with the American College of Radiology (ACR) Learning Network ImPower Program would allow them to merge proven Six Sigma methodologies with ImPower’s structured framework, creating a robust, high-reliability follow-up system. Central to achieving this goal was selecting a technology platform that delivers consistent reliability throughout the patient and provider journey. With Inflo Health as their chosen solution, STHS effectively aligned people, processes, and technology to launch the initiative.
Determining The Root Causes of Missed Follow-ups
STHS integrated the structured rigor of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) methodology, technology-driven analytics from Inflo Health, and the collaborative framework of the ImPower Program to address the root causes of missed follow-ups systematically. The following key steps drove this targeted approach:
- Comprehensive Workflow Mapping: Engaged cross-functional teams—including radiologists, referring providers, care coordinators, and administrative staff—in collaborative sessions to visualize end-to-end processes, clearly identifying critical points of miscommunication and operational delays.
- Root Cause Analysis: Leveraged Six Sigma principles to analyze baseline follow-up completion rates, pinpointing specific bottlenecks within documentation practices, scheduling procedures, and communication workflows.
- Targeted, Technology-Driven Interventions: Established clear baseline metrics for follow-up adherence and appropriateness, defined improvement targets, and laid the groundwork for implementing automated identification, tracking, and orchestration of follow-up care.
A multidisciplinary project team, including technology experts from Inflo Health, guided the cause and effect analysis to guide the development of interventions expected to deliver the greatest reliability and operational efficiency improvements. Progress and outcomes were routinely shared through structured ACR ImPower Program updates, fostering peer-to-peer collaboration and facilitating shared learning across participating organizations.
Establishing an Environment for High-Reliability Success
By thoroughly identifying the underlying causes of missed follow-ups and clearly understanding their impact on patients, providers, and operational efficiency, STHS established a foundation positioned for successful implementation of a high-reliability follow-up program. Based on insights derived from their comprehensive root-cause analysis, STHS strategically prioritized the following:
- Consistent, Clear Recommendations: Standardizing radiology recommendations to ensure clarity, actionable guidance, and uniformity across all follow-up communications.
- Enhanced Communication Pathways: Streamlining processes to improve communication and accountability between radiologists, referring providers, and care coordinators, ensuring follow-up actions are consistently tracked and completed.
- Empowering Patient Engagement: Implementing patient-centered communication strategies to clearly convey next steps, increasing patient engagement, adherence, and satisfaction.
- Automation and Scalability: Leveraging automation to dramatically reduce manual workloads, enhance operational efficiency, and establish a scalable, sustainable follow-up infrastructure.
With Inflo Health’s support, STHS prioritized indeterminate lung nodule follow-up as the first program to adapt to the high-reliability framework. The team established clear baseline metrics and performance targets, including:
- 60% improvement in closure rates for indeterminate lung nodule follow-ups.
- 78% improvement in the quality and consistency of documentation for additional imaging recommendations.
- 95% reduction in manual follow-up tracking tasks, significantly increasing efficiency and allowing staff to focus more on direct patient care.
Key Takeaways and Next Steps
By combining the rigor of Six Sigma methodologies, advanced follow-up identification and care orchestration capabilities enabled by Inflo Health, and the structured, collaborative resources provided by the ACR ImPower Program, STHS is effectively positioned to drive the reliability recommendations for additional imaging management. This integrated approach equips STHS with a proactive, resilient system designed to continuously identify and resolve workflow gaps, ultimately strengthening patient safety, enhancing care continuity, and driving operational excellence.
This project highlights the transformative potential of structured, collaborative, and technology-driven approaches to healthcare quality improvement. STHS’s experience provides a repeatable blueprint, illustrating how systematic, data-driven interventions, coupled with cutting-edge technology and collaborative learning environments, can drive sustained enhancements in healthcare delivery. As the program continues to evolve, STHS remains committed to ongoing process refinement, nurturing a culture of continuous improvement, and fostering shared accountability across the organization.
Adapted from “Closing the Loop on Incidental Findings: St. Tammany Health System’s (STHS) Transformative Journey Combining Six Sigma, Technology, and the ACR ImPower Program” by Tiffany Raiford, B.S., R.T. (R)(CT)(MR), Director, Imaging Service, presented during the 2025 ACR Annual Conference.
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