Abstract Details

Title Resident Lumbar Puncture Clinic at Geisinger Health System: A Single Program Needs Assessment for Quality Improvement

Topic Research Methodology, Education, and History

Presentation(s) Research Methodology and Education Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 021

Background Neurology residents are expected to acquire the skills to perform LPs independently. A previous study reported that over 80% of LPs attempted by trainees were successfully completed. At our program we require postgraduate year (PGY) 2 residents to complete 5 successful LPs with direct supervision before performing them independently. We implemented a resident LP clinic to provide an early supervised clinical experience to meet this requirement.

Objective

To review the volume, indications, pre-procedure testing, success rate and complications in the Geisinger Neurology resident lumbar puncture (LP) clinic, and to identify areas for improvement.

Design/Methods Retrospective review of patients seen in LP clinic during academic year 2019. LPs were performed without ultrasound guidance.

Results There were 69 LP clinic slots available, and 50 were filled (72%). A total of 47 LPs were attempted: 2 by PGY1s (4%), 12 by PGY2s (26%), 18 by PGY3s (38%) and 15 by PGY4s (32%). The most common indication was demyelinating disease (36%). Overall, 45 patients (96%) had brain imaging and all had coagulation tests before the LP. Mean body mass index (BMI) of all patients was 30.4 Kg/m². Out of 47 attempted LPs, 35 (74%) were successful. In only 1 of these cases the supervising attending successfully performed the LP after the resident’s attempt. Mean BMI for unsuccessful LPs was 38.3 Kg/m². Complications occurred during or after 8 LPs (17%), of which 3 were unsuccessful. The most common complication was headache in 5 patients (11%) and only 1 required an epidural blood patch.

Conclusions Resident LP clinic is a feasible method to provide longitudinal procedural training for residents. Our success rate was lower than what has been reported by others. Areas for improvement include adjustment of LP clinic slots to maximize use, prioritizing scheduling of PGY2s and incorporation of ultrasound to increase success rate.

Authors/Disclosures
Stephanie Wyrostek, DO PRESENTER	Dr. Wyrostek has nothing to disclose.
Christopher J. Whiting, DO	Dr. Whiting has nothing to disclose.
Cortney Houtz, LPN (Geisinger Health System-Neurology Residency Program)	Ms. Houtz has nothing to disclose.
J. David Avila, MD (Geisinger Medical Center)	Dr. Avila has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Avila has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alnylam Pharmaceuticals. Dr. Avila has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for argenx. Dr. Avila has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion Pharmaceuticals. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZeneca. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Takeda.