{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T17:18:17Z","timestamp":1763140697127,"version":"build-2065373602"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,4,8]],"date-time":"2014-04-08T00:00:00Z","timestamp":1396915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>(1) Confirm the positive value stream of office\u2010based 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case series with historical controls using chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary Veterans Administration Hospital (university\u2010affiliated).<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>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\u20102012; 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Value stream mapping prior to and after implementing office\u2010based 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\u00a0days requiring a maximum 17 steps to a range of 0 to 48\u00a0days, necessitating only a maximum of 9 steps. Office\u2010based 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\u2010based ultrasound also changed the clinical management of specific patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Lean Six Sigma reduces waste and optimizes quality and accuracy in manufacturing. This is the first known application of Lean Six Sigma to office\u2010based USFNA in the evaluation of head and neck lesions. The literature supports the value of office\u2010based ultrasound to patients and health care systems.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599814528659","type":"journal-article","created":{"date-parts":[[2014,4,9]],"date-time":"2014-04-09T01:14:08Z","timestamp":1397006048000},"page":"65-72","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Lean Six Sigma Applied to Ultrasound Guided Needle Biopsy in the Head and Neck"],"prefix":"10.1002","volume":"151","author":[{"given":"Bruce H.","family":"Matt","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather K.","family":"Woodward\u2010Hagg","sequence":"additional","affiliation":[{"name":"Systems Redesign Richard L. 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