How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center

Abstract

BACKGROUND AND PURPOSE:Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months.

Accuracy of cranial ultrasound in the diagnosis of hydrocephalus in children under 6 months of age keeping CT scan as a gold standard

“…5 All newer radiological protocols are aimed to minimize the radiation exposure. 14 In our study the sensitivity of USG to detect hydrocephalus was 88.9% the specificity was 58.1%. This makes sonography not an ideal investigation for hydrocephalus but it can be used as a better screening tool.…”

The sustainability of Lean in pediatric healthcare: a realist review

“…We obtained no additional data by contacting Saskatoon Children’s Hospital, Cincinnati Children’s hospital, and Virginia Mason hospital. Eleven documents [ 42 – 52 ] were included in the review and were used to refine the initial CMO hypotheses, eight documents from our database search [ 42 – 49 ], one from our citation search [ 51 ], and two documents from our gray literature search [ 50 , 52 ] (Fig. 1 ).…”

“…Of the 11 included documents, six were published primary research studies [ 42 , 43 , 45 , 47 – 49 ], two were published quality improvement case studies [ 44 , 46 ], and three were unpublished quality improvement case reports [ 50 – 52 ] found from our citation searching [ 51 ] and gray literature searching [ 50 , 52 ] (Table 1 ). Of the 11 documents, seven used Lean exclusively [ 44 , 45 , 48 – 52 ]; two used Lean and Six Sigma [ 42 , 43 ]; one used a combination of Lean, Six Sigma, and the Institute for Healthcare Improvement (IHI) Model for Improvement [ 46 ]; and another used Lean with “other” QI classic methods [ 47 ]. Improvements were targeted at the meso (e.g., unit or organization level) ( n = 8) [ 42 – 49 ] and macro (e.g., policy, system) ( n = 3) [ 50 – 52 ] levels of the healthcare system.…”

“…Of the 11 documents, seven used Lean exclusively [ 44 , 45 , 48 – 52 ]; two used Lean and Six Sigma [ 42 , 43 ]; one used a combination of Lean, Six Sigma, and the Institute for Healthcare Improvement (IHI) Model for Improvement [ 46 ]; and another used Lean with “other” QI classic methods [ 47 ]. Improvements were targeted at the meso (e.g., unit or organization level) ( n = 8) [ 42 – 49 ] and macro (e.g., policy, system) ( n = 3) [ 50 – 52 ] levels of the healthcare system. No improvement targeted the individual, micro level.…”

“…No improvement targeted the individual, micro level. Documents focused on a variety of problems, clinical ( n = 1) [ 42 ], process ( n = 2) [ 43 , 48 ], clinical and process (n = 1) [ 46 ], or process and system problems ( n = 7) [ 44 , 45 , 47 , 49 – 52 ].…”