Lumbar punctures (LPs) are a common investigation on the medical take. Anecdotally, an increasing proportion of LPs take place on the emergency theatre list (CEPOD). This often leads to delays. This audit aimed to determine the number of LPs done on CEPOD and indications for referral. We also evaluated sources of delay as a result of LPs, with the goal of improving theatre efficiency. Finally, we examined whether a lack of procedural training opportunities among medics is contributing to the rise in LP referrals.

Methods

This was a retrospective audit of all LPs on adult patients at Watford General Hospital (WGH) between Nov 2022 - Jan 2023. Data was collected on location and indication. For CEPOD LPs, additional data was gathered on reasons for referral and causes of potential delay including availability of CT head and blood results. Medical trainees were surveyed to evaluate confidence levels and identify barriers to LPs on the ward.

Results

Between Nov 2022 and Jan 2023, 46 lumbar punctures took place at WGH. Excluding ICU + LP Clinic, 33% of all adult LPs were done on CEPOD. The majority of LPs (70%) were attempted by the medical team prior to referral. Common reasons for CEPOD referral included ‘unsuccessful on ward’ (40%) and ‘high BMI’ (30%). Despite 100% of CT head and 90% of blood results being available only 30% were documented. The average time from booking to procedure was 12 hours, and average time from sending to arrival in theatres was 40 minutes. Thirty-seven medical trainees responded to the survey. Fifty-nine% were ‘not at all confident’ with lumbar punctures. Forty-five% said their workload adversely affects procedural training daily. All said they would find LP teaching helpful.

Discussion

A significant proportion of LPs are taking place on the CEPOD list. Delays are taking place due to poor documentation of necessary results.  There is evidence of under confidence with LPs among medical trainees and high workload is impacting procedural training. In response to these findings an ‘LP Checklist’ was introduced to improve documentation and efficiency.

A re-audit of LPs on CEPOD was conducted from May-July 2023. This showed an improvement in documentation of CT head and blood results (61% vs 30%). The average time from sending to arrival in theatres was reduced from 40 mins to 23 mins. There was also evidence of LP teaching for medics occurring on the CEPOD list.  Formal LP teaching is currently being organised.