WIP 114 - Ultrasound Guided Lumbar Puncture Simulation with Utilization of an Infant Phantom Model to Increase First-Time Success Rate in Lumbar Punctures in a Pediatric Emergency Room, a QI Project
Fellow Physician Akron Children's Hospital Akron, Ohio, United States
Background: Lumbar punctures (LP) in infants are a common procedure in the pediatric emergency department (ED). Studies have shown that standard LPs performed by physicians without ultrasound guidance are less successful. The most critical step for a successful LP is associated with the correct identification of landmarks, which can be overcome with point-of-care ultrasound. Objective: To identify if there is a significant proportion of LPs performed in our pediatric EDs that fail to meet the first-time success rate at our institution and, if so, implement a quality improvement intervention using the Plan-Do-Study-Act model with our pediatric emergency medicine fellows and attendings. Design/Methods: Our research plans were submitted to the IRB of our institution and approved for a quality improvement initiative to commence in December 2022. A 4-month retrospective chart review of LPs in patients less than 2 years-old in our pediatric EDs, comparing the use of palpation alone and ultrasound guidance (Phase I), was completed. Data including first time success rate, position of the patient, interspace used, cerebrospinal fluid color and number of attempts was obtained. The results revealed a 61.5% first-time attempt success rate with palpation alone, leaving room for improvement. A prospective intervention of teaching identification of spinal landmarks with ultrasound using an infant phantom model to mark best area of needle insertion, developing a unique online teaching module along with a pre- and post-survey over a 4-month period (Jan-April 2023) (Phase II) was accomplished. Finally, an additional 12-month period (Phase III) includes continued teaching, ultrasound guided assistance available when performing LPs in the pediatric ED and raising awareness of this tool in the ED. Data collection has started from January 2023 and will be complete by February 2024. Preliminary data has already shown great promise in the areas of both first-time success rate and decreased incidence of traumatic lumbar punctures.
