Lean Six Sigma Applied to Ultrasound of the Head and Neck: Changing Patient Management

Abstract

Objectives:

1) Confirm the positive value stream of office-based ultrasound using Lean Six Sigma. 2) Demonstrate how ultrasound reduces time to diagnosis, costs, patient inconvenience and travel, exposure to ionizing radiation, intravenous contrast, and laboratory tests.

Methods:

A retrospective review of adults with head and neck lesions between 2009-2012 at a veterans administration hospital was conducted. Affiliated interventions: Ultrasound evaluation of head and neck lesions. Outcome Measurements: Type of diagnostic tests, time to diagnosis, radiation exposure, episodes of patient travel, and final diagnosis. Independent variables: Age and gender of patient. Preliminary analyses: Value stream mapping prior to and after implementing office-based ultrasound confirmed the time from consult request to final diagnosis of a head and neck lesion was reduced from a range of 49-146 days, requiring 17 steps, to a range of 7-29 days, requiring 9 steps.

Results:

Office-based ultrasound for evaluation of head and neck lesions reduced costs, time to diagnosis, risks and inconvenience to patients, radiation exposure, and unnecessary laboratory and patient complaints, while increasing staff satisfaction. In addition, office-based ultrasound also changed the clinical management of specific patients.

Conclusions:

Lean Six Sigma is used to reduce waste and optimize quality and accuracy in manufacturing. This is the first known application of Lean Six Sigma to office-based ultrasound in the evaluation of head and neck lesions. The value of office-based ultrasound to patients, healthcare systems, and healthcare teams is unquestionable.