P2.I172: Optimizing for Successful Neonatal Procedures with Ultrasound (OPTIMUS) Quality Improvement: Lumbar Puncture

Purpose/Objectives: Lumbar puncture (LP) is a critical procedure for diagnosing central nervous system infections in neonates but is fraught with high failure rates. Unsuccessful attempts lead to increased pain, risk of complications, and undiagnostic studies. The OPTIMUS QI initiative seeks to enhance LP success rates in the Neonatal Intensive Care Unit at Los Angeles General Medical Center by integrating POCUS into standard LP procedures. The project targets a 20% improvement in successful LP attempts within one year.

Design/Methods: This quality improvement effort began by establishing a baseline of LP success and failure rates prior to POCUS integration. Experienced faculty and superusers then facilitated POCUS training for Neonatal-Perinatal Medicine (NPM) fellows. Senior NPM fellows provided in-person guidance during POCUS-guided LPs. The procedure's success was monitored prospectively through documentation data extraction, forming the basis for the Plan-Do-Study-Act (PDSA) cycle for continuous refinement.

Results: The proportion of LP sessions using POCUS guidance increased substantially from 0% to a median of 73%. The percent of overall LP success, average number of attempts per LP session, and incidence of traumatic LP exhibited nonspecial cause variation throughout the study period. The percentage of overall LP success was not statistically significantly different by LP techniques with and without POCUS.

Conclusion/Discussion: The early outcomes of the OPTIMUS project indicate that structured training significantly enhances the adoption of POCUS in neonatal LP procedures. However, additional support is necessary to improve providers’ comfort and procedural success. The documentation and data extraction processes also require enhancement for better accuracy and automation.