Purpose:To successfully develop a department-wide standardized structured reporting program and achieve widespread adoption throughout the radiology department. Materials and Methods:A structured reporting work group was formed in February 2010 to oversee development of standardized structured reports for a radiology department of 36 radiologists at a tertiary care children's hospital. The committee reached consensus on report organization and provided written guidelines and checklists for division representatives to aid in creation of the structured reports. Report drafts were reviewed by a subcommittee and revised until agreement was reached with the report author. Each report was vetted by all radiologists who would be using the report, and further revisions were made, as appropriate. Reports were then entered into the speech recognition system so that each report was associated with a procedure code or a group of codes from the radiology information system. This enabled automatic report population within the speech recognition system. The initiative was completed by September 2011. Quarterly audits were performed to evaluate for adherence to the standard report format and use of the normal report in cases in which the radiologist believed the study was normal. In August 2012, radiologists were surveyed as to their impressions of the structured reporting program. Results:A total of 228 standardized structured reports were created within 2 years after initiation of the project, corresponding to 199 000 (94%) of 212 000 departmental studies by volume. By the end of the implementation period in September 2011, all 223 (100%) audited reports adhered to the standard report format and 80 (99%) of 81 reports adhered to the normal report. Radiologist feedback was largely favorable. Conclusion:Standardized department-wide structured reporting can be implemented in a radiology department, with a high rate of adoption by the radiologists.q RSNA, 2013

By clearly defining expectations for an appropriate clinical history and establishing system and organizational mechanisms to facilitate verifiable compliance, we were able to successfully and sustainably improve the consistency with which radiography examinations were accompanied by a complete clinical history.

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As radiology departments continue to increase in size and complexity, the process of improving and maintaining excellent performance is becoming increasingly challenging. In response, a systematic process for efficiently implementing and sustaining measurable improvement in our radiology department has been developed, which targets focused aspects of individual performance that contribute to overall departmental quality. Projects designed to achieve such improvements have been called quality improvement and confirmation (QuIC) projects. The QuIC project process involves a project champion, medical expert, technical expert, quality improvement technologist specialist, and appropriate leaders, managers, and support personnel. The project champion conducts a preliminary investigation and organizes team members, who define the desired performance through consensus, establish data collection and analysis procedures, and prepare to launch the project. Once launched, the QuIC project process follows an execution period that is divided into four phases: (a) project launch phase, (b) support phase, (c) transition phase, and (d) maintenance phase. The first three phases focus on education, group-level feedback, and individual feedback, respectively. Weekly audits are performed to track performance improvement. Data collection, analysis, and dissemination processes are automated to the extent possible. To date, four such projects have been successfully conducted. The QuIC project concept is an attempt to apply the principles of process improvement to the process of process improvement by enabling any member of a radiology department to efficiently and reliably spearhead a quality improvement project. We consider this to be a work in progress and continue to refine the process with the goal of eventually being able to conduct many projects simultaneously.