title: 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: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.) atekes1@jhmi.edu.
authors.forename: A
authors.identifier: 0000-0002-4078-1484
authors.initials: A
authors.lastname: Tekes
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery (E.M.J., G.J.).
authors.forename: E M
authors.identifier: 0000-0001-9306-9290
authors.initials: EM
authors.lastname: Jackson
authors.affiliation: Department of Pediatrics (J.O.), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: J
authors.identifier: 0000-0001-5578-818X
authors.initials: J
authors.lastname: Ogborn
authors.affiliation: Department of Radiology (S.L., M.B.), Russell H. Morgan Department of Radiology and Radiological Science.
authors.forename: S
authors.identifier: 0000-0002-9131-1183
authors.initials: S
authors.lastname: Liang
authors.affiliation: Department of Radiology (S.L., M.B.), Russell H. Morgan Department of Radiology and Radiological Science.
authors.forename: M
authors.identifier: 0000-0001-5295-9350
authors.initials: M
authors.lastname: Bledsoe
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.).
authors.forename: D J
authors.identifier: 0000-0001-7290-3135
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery (E.M.J., G.J.).
authors.forename: G
authors.identifier: 0000-0001-9607-6867
authors.initials: G
authors.lastname: Jallo
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.).
authors.forename: T A G M
authors.identifier: 0000-0003-2302-6724
authors.initials: TA
authors.lastname: Huisman
mesh_terms: D002648:Child; D017598:Efficiency, Organizational; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D011873:Radiology Information Systems; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D017749:Total Quality Management / Q000379:methods*