More Than EEG Electrodes: Building Safer Neurodiagnostic Care Through Psychological Safety and Lean Six Sigma Methodology.

Abstract

At Ann & Robert H. Lurie Children's Hospital of Chicago, the increasing volume of video EEGs, extended diagnostic recording times, higher patient acuity, and variability in EEG connection techniques among neurodiagnostic technologists (NDTs) contributed to a rise in device-related skin injuries. In response, the Epilepsy Monitoring Unit (EMU) adopted Lean Six Sigma, a structured improvement methodology that combines the principles of Lean (waste reduction) and Six Sigma (defect reduction). This approach was implemented alongside humble inquiry and a psychologically safe environment, empowering the NDT team to identify root causes and drive meaningful change.Through root cause analysis, the neurodiagnostic team developed and implemented six key interventions: Targeted retraining in skin education and terminologyIntegrated evidence-based products (Mepitel and Mepilex)Strengthened collaboration with bedside nursesImplemented standardized work for EEG electrode application and head-wrapping techniquesStandardized skin checks and documentationEstablished a skin compliance monitoring system using the electronic medical recordAs a result, over the past three fiscal years, the rate of video EEG electrode-related injuries has decreased by 70%, while NDT compliance with skin checks and documentation has improved from 26% to 85%.This quality improvement article examines the application of the Define, Measure, Analyze, Improve, and Control (DMAIC) framework in achieving these outcomes.