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

Aylin Tekes, Eric Jackson, Jean Ogborn, S. Liang, M. Bledsoe, D. J. Durand, George Jallo, T. A G M Huisman

Research output: Contribution to journalArticle


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. MATERIALS AND METHODS: We applied a Lean Six Sigma methodology using a multidisciplinary team at a quaternary care academic children's center. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system. Data collection continued postintervention and during the control phase (each for 3 months). The percentage of neuroimaging per technique (head CT, head ultrasound, ultrafast brain MR imaging, and routine brain MR imaging) was recorded during each phase. RESULTS: The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases (Z-test, P = .0001). CONCLUSIONS: Our lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders and increased use of ultrafast brain MR imaging.

Original languageEnglish (US)
Pages (from-to)990-996
Number of pages7
JournalAmerican Journal of Neuroradiology
Issue number6
StatePublished - Jun 1 2016


ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

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