Improving the availability of clinical history accompanying radiographic examinations in a large pediatric radiology department

The purpose of this quality improvement initiative was to improve the consistency with which radiologists are provided a complete clinical history when interpreting radiography examinations performed in the outpatient and emergency department settings. The clinical history was considered complete if it contained three elements: nature of the symptoms, description of injury, or cause for clinical concern; duration of symptoms or time of injury; and focal site of pain or abnormality, if applicable. This was reduced to three elements: "what-when-where." A goal was established that 95% of the clinical histories should contain all three elements. To achieve this goal, technologists supplemented referring clinicians' history. The project was divided into four phases: launch, support, transition to sustainability, and maintenance. During the support phase, results of automated weekly audits automatically populated group-level performance reports. During the transition to the sustainability phase, audit results populated individual-level performance reports. During the maintenance phase, quarterly audit results were incorporated into technologists' employee performance goals. Before initiation of the project, 38% (76/200) of radiography examinations were accompanied by a complete clinical history. This increased to 92% (928/1006) by the end of the 15-week improvement phase. Performance was sustained at 96% (1168/1213) 7 months later [corrected]. 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.