An Emergency Department Quality Improvement Project to Decrease Lumbar Puncture Rates in Febrile Infants 22 to 28...

Area of Science:

• Pediatrics
• Quality Improvement Science
• Infectious Disease Management

Background:

• Historically, universal lumbar puncture (LP) was standard for well-appearing, febrile infants aged 22-28 days.
• The American Academy of Pediatrics updated guidelines in 2021, recommending LPs only when inflammatory markers are abnormal for this age group.
• A quality improvement project was initiated to decrease LP rates in emergency departments for febrile infants aged 22-28 days.

Purpose of the Study:

• To reduce lumbar puncture (LP) rates in febrile infants aged 22-28 days in the emergency department.
• To achieve a significant decrease from a baseline rate of 87% within one year.
• To ensure reductions were equitable across all racial and ethnic groups.

Main Methods:

• Implementation of a quality improvement framework utilizing Plan-Do-Study-Act cycles.
• Multidisciplinary team review of literature, local epidemiology, and key drivers for LP performance.
• Departmental education, clinical pathway updates, and integration of clinical decision support tools.

Main Results:

• Lumbar puncture (LP) rates decreased from a baseline of 87% to 44% during the intervention period.
• No significant disparities in LP rates were observed across different racial/ethnic groups.
• Procalcitonin testing rates increased, and no adverse events related to missed bacterial meningitis were detected.

Conclusions:

• Quality improvement initiatives effectively and safely reduced lumbar puncture (LP) rates in febrile infants aged 22-28 days.
• The interventions included education, updated clinical pathways, and decision support.
• The project demonstrated a successful reduction in invasive procedures while maintaining patient safety.