Eliminating Unnecessary Diagnostic Imaging and Labs

In the era of value-based health care, reducing waste and decreasing cost is a priority for health care systems. A primary challenge in improving health care value is to maintain or improve outcomes while reducing the cost of care. Lean Production, widely used in manufacturing industries, aims to reduce cost and eliminate waste and can be used to achieve similar ends in medicine. By assimilating these principles, health care systems can identify wasteful processes to further the Triple Aim (improve outcomes, reduce costs, and improve patient experience). At Oregon Health & Science University, an initiative was created to evaluate the efficacy of imaging obtained by the neuroscience service line and limit nonessential images. A single standardized procedure, retrosigmoid craniectomy for microvascular decompression, was analyzed. Retrospective analyses of institutional data were performed prior to prospective changes in clinical practice. Data collected after implementation of the clinical changes demonstrated similar outcomes and reduced cost, thereby increasing value.