Fewer than 1 in 10 imaging follow-ups for incarcerated patients were completed on time

Design

Single-centre retrospective review of radiology reports

Population

243 follow-up recommendations for 164 incarcerated ED and inpatient patients, 2017-2024

Primary outcome

Completion of recommended follow-up within the adherence window

Effect

8.6% completed as outpatients on time; 33.3% had any documented follow-up

A single US academic centre reviewed radiology reports from 2017 to 2024 for incarcerated patients seen in the emergency department or as inpatients (JACR, 7 October 2026). After text screening and manual review, 243 reports from 164 patients contained a definite recommendation for follow-up imaging, endoscopy or biopsy.

Of 140 recommendations with a clear interval, only 12 (8.6%) were completed as outpatients within the adherence window. Any follow-up at the institution was documented for 81 of 243 (33.3%), and a third of those happened only incidentally at a later emergency visit or readmission.

Patients in custody depend on correctional health services to arrange outpatient care, and recommendations buried in a report rarely cross that boundary. The authors call for closed-loop pathways; the same logic applies to any group whose care is fragmented across systems.

• When reporting on a patient in custody, state the recommended test and interval explicitly in the impression.
• Send actionable follow-up recommendations through a tracked closed-loop system, not only the report.
• Include the correctional health service in discharge communication where permitted.
• Consider completing a recommended test during the index admission when it is safe and reasonable.
• Audit follow-up completion for other fragmented-care groups, such as people without a regular GP.

Why it matters

A recommendation that never reaches the person who books the scan is, in practice, no recommendation at all.

Don't overread it

Follow-up completed outside this institution was not captured, so the true completion rate may be higher.

The statistics, in plain English

The 8.6% figure applies only to the 140 recommendations with an interpretable interval; the broader 33.3% counts any later follow-up at all.

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