Lean Six Sigma Applied to Ultrasound Guided Needle Biopsy in the Head and Neck.
(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.



Case series with historical controls using chart review.



Tertiary Veterans Administration Hospital (university-affiliated).



Patients with a consult request or decision for ultrasound guided fine needle aspiration (USFNA) from 2006 to 2012. Process evaluation using Lean Six Sigma methodologies; years study conducted: 2006-2012; outcome measurements: type of diagnostic tests and imaging studies including CT scans with associated radiation exposure, time to preliminary and final cytopathologic diagnosis, episodes of patient travel.



Value stream mapping prior to and after implementing office-based ultrasound confirmed the time from consult request or decision for USFNA to completion of the USFNA was reduced from a range of 0 to 286 days requiring a maximum 17 steps to a range of 0 to 48 days, necessitating only a maximum of 9 steps. Office-based USFNA for evaluation of head and neck lesions reduced costs, time to diagnosis, risks and inconvenience to patients, radiation exposure, unnecessary laboratory, and patient complaints while increasing staff satisfaction. In addition, office-based ultrasound also changed the clinical management of specific patients.



Lean Six Sigma reduces waste and optimizes quality and accuracy in manufacturing. This is the first known application of Lean Six Sigma to office-based USFNA in the evaluation of head and neck lesions. The literature supports the value of office-based ultrasound to patients and health care systems.
Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA bmatt@iupui.edu.
Bruce H
BH
Matt
Systems Redesign, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA.
Heather K
HK
Woodward-Hagg
Department of Pathology and Laboratory Medicine, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA.
Christopher L
CL
Wade
Systems Redesign, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA.
Penny D
PD
Butler
Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA Systems Redesign, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA.
Mimi S
MS
Kokoska
D044963:Biopsy, Fine-Needle / Q000191:economics / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000473:pathology* / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology; D013965:Thyroidectomy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000191:economics; D014481:United States; D014728:Veterans
Six Sigma methodology; cytologic interpretation; fine needle aspiration; head and neck masses; lean management; ultrasound