To enhance patient care and efficiency of lumbar punctures performed through data-driven organizational change.

Lumbar puncture (LP) is a common procedure both within and outside of neurology which requires multidisciplinary coordination of logistical and systems-based processes. Without a shared protocol, errors and delays may adversely impact patient care.

Process mapping for LPs was carried out within a single academic hospital. Formalized needs assessment of multidisciplinary stakeholders was completed using direct observations and a pre-implementation survey. A streamlined protocol was implemented with additional planned iterative assessments using a PDSA framework.

A total of 29 nurses and providers were surveyed: areas of concern included CSF testing, nurse role in procedure and handling, scheduling and coordination for Neuroradiology (NR), and communication with ordering providers. Results showed 34% had limited comfort in their role, 73% were unaware of lab requirements for specialized CSF testing, and over 70% noted poor communication between stakeholders. Providers estimated time lost per procedure of > 30 minutes dedicated to coordination of specimen handling, whereas the mean time to patient scheduling for outpatient NR was 17 days (range 4-41). Stepwise implementation led to a standard operating procedure, requiring early communication between providers, lab and NR; limitations included embedded system factors like reporting and methods of communication constraints. Result collection is ongoing with planned post-implementation assessments, including time and qualitative measures, with an initial positive reception from stakeholders. Additional interventions include dedicated instruction which is ongoing for bedside nursing and providers in identified areas.

Formalized assessment of LP procedures revealed multiple areas for improvement, identifying communication and logistical concerns. Through a rolling assessment post-intervention phase and ongoing PDSA, we anticipate that standardization with a focus on communication will lead to improved procedural efficiency, patient care, and provider experience when completing lumbar puncture.