Enhancing Maternal Outcomes by Standardizing Epidural Analgesia Practice: A Quality Improvement Project in a...

​Introduction A critical service gap was identified at a secondary military hospital in Taif City, characterized by periods of zero utilization of epidural analgesia (EA) and an elevated baseline cesarean section (CS) rate. This quality improvement (QI) project was initiated to recover EA services, reduce maternal operative morbidity, and improve clinical outcomes through a standardized multidisciplinary practice change. ​Materials and methods Using a quasi-experimental (retrospective-prospective) design, clinical metrics from the baseline period (January-September 2024) were compared with the post-intervention period (January-September 2025). A multidisciplinary team (anesthesia, obstetrics, nursing, and administration) implemented a three-cycle Plan-Do-Study-Act (PDSA) framework. Interventions included root cause analysis, resource optimization, and data-driven monthly performance huddles. Patient satisfaction was assessed via a prospective cross-sectional comparative study. ​Results Following the intervention, EA utilization significantly increased from 4.9% (n = 30/610) in 2024 to 13.5% (n = 85/628) in 2025 (χ² (1, N = 1,238) = 26.24, p < .001; Cramer's V = 0.15). The CS rate decreased from 40.2% (n = 410/1,020) to 32.5% (n = 302/930) (χ² (1, N = 1,950) = 12.19, p < .001; Cramer's V = 0.08), while spontaneous vaginal deliveries (SVD) increased from 55.9% (n = 570/1,020) to 63.8% (n = 593/930) (χ² (1, N = 1,950) = 13.06, p < .001; Cramer's V = 0.08). Instrumental delivery rates remained stable at 3.9% (n = 40/1,020) and 3.8% (n = 35/930), respectively (χ² (1, N = 1,950) = 0.15, p = .698). In 2025, patients receiving EA reported significantly higher satisfaction (93.6%; n = 80/85) compared to the non-EA group (76.5%; n = 415/543) (t (626) = 35.15, p < .001). Mean staff satisfaction during implementation was 74.6% (n = 47/63). Conclusions This standardized, consultant-led model successfully optimized labor analgesia and delivery outcomes, providing a resilient and reproducible framework for enhancing maternal safety and institutional resource stewardship at a national scale.