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

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...