Table 2.

Patient pathway with mapped barriers and domains

Patient pathway	Barrier identified	Domain
Patient presents at hospital	Potential long wait time in Accident and Emergency	Environmental context and resources
Patient shows clinical features that indicate a lumbar puncture is required	Relies on clinical feature recognition	Knowledge
		Memory
		Beliefs about consequences
Decision is made to perform a lumbar puncture	May require several people to make this decision	Professional role
		Emotion
		Social influences
Patient is admitted to ward/medical admissions unit for a lumbar puncture to be performed	Patient will need to be re-clerked	Beliefs about consequences
		Environmental resources and context
Staff allocated to perform a lumbar puncture	Shift pattern, other duties, perceived importance of a lumbar puncture	Beliefs about capabilities
		Beliefs about consequences
		Emotion
Equipment and supervision found: Lumbar puncture ready to go ahead	Need to know what equipment is needed, where it is and finding someone to supervise	Knowledge
		Memory
Lumbar puncture performed	Many external factors as well as skill	Skills
		Beliefs about capabilities
		Emotion
Results available. Management plan made	Who can make the plan, delays with results and knowledge to interpret	Professional role
		Beliefs about consequences
		Social influences
Additional test needed	Who can action this? Further delays can occur here	Beliefs about social comparison
		Consequences
		Knowledge