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Using Lean Six Sigma to Improve Delayed Intracranial Hemorrhage Screening in a Geriatric Trauma Population

Birmingham, Lauren E., PhD, MA; Sedorovich, Ashley, MS; Mann, Nolan, MD; George, Richard L., MD, MSPH, FACS

doi: 10.1097/QMH.0000000000000186
Original Articles

Purpose: Geriatric trauma patients taking preinjury anticoagulant or antiplatelet (ACAP) medications are at greater risk for delayed intracranial hemorrhage (DICH), a rare but potentially life-threatening condition. Routine repeat head computed tomography (RRHCT) scans can identify DICH. Our objective was to decrease the rate of missed RRHCT in a level 1 Midwest trauma center geriatric minor trauma population on preinjury ACAP medications.

Objective: The objective of the quality improvement project was to identify the root cause of the missed RRHCTs and to implement a comprehensive solution to reduce rates of missed RRHCTs.

Methods: Medical records from before and after the intervention were evaluated. Frequencies and percentages were calculated. In addition, χ2 and logistic regression were utilized. The Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, and Control) process was used to drive process improvement.

Results: At baseline, 15% (41 of 267) of RRHCTs were missed. After solution implementation, missed RRHCTs dropped to 4% (2 of 50). Of the 2 that were missed, zero were clinically inappropriate misses, making the postimplementation rate effectively 0%.

Conclusion: The LSS DMAIC process helped health care professional to facilitate improved adherence to the department's practice guideline with respect to RRHCT. Adherence with this guideline can help providers identify patients with DICH, a potentially life-threatening condition.

Departments of Surgery (Drs Birmingham, Mann, and George) and Performance Solutions (Ms Sedorovich), Summa Health System-Akron City Campus, Ohio; College of Public Health, Kent State University, Ohio (Dr Birmingham); and Northeast Ohio Medical University, Rootstown (Dr George).

Correspondence: Lauren E. Birmingham, PhD, MA, Kent State University, 800 Hilltop Drive, Moulton Hall, PO Box 5190, Kent, OH 44242 (;

The authors declare no conflicts of interest.

© 2018Wolters Kluwer Health | Lippincott Williams & Wilkins