Related Experiment Video
Updated: Aug 6, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Neuraxial labor analgesia outcomes in a referral center in Vietnam: a quality improvement program incorporating
Chinh Minh Quach1, Chinh Phuong Duong2, Nhan Thi Ho3
1Department of Anesthesiology, Vinmec Healthcare System, Ha Noi, Viet Nam; College of Health Sciences, Vin University, Hanoi, Viet Nam.
Background:
Despite modern neuraxial techniques, variability in labor epidural analgesia quality may adversely affect maternal experience. We evaluated whether a structured quality improvement program based on continuous monthly audit-feedback cycles, incorporating Statistical Process Control methodology, could improve labor analgesia outcomes and maternal satisfaction.
Methods:
This single-center prospective quality improvement study was conducted at a tertiary hospital performing approximately 3,000 deliveries annually (labor epidural analgesia rate ∼ 75%), Hanoi, Vietnam, from December 2022 to December 2024. Three primary quality drivers (midwife-assessed analgesia quality, midwife-assessed effectiveness of pushing efforts, and self-reported maternal satisfaction with labor analgesia) were evaluated daily on the labor ward and scored monthly on a validated 5-point scale. Cases with a score < 4 triggered departmental anesthesiology review and targeted corrective interventions. Intrapartum cesarean deliveries were excluded from the primary analysis. Differences in score values between time points and trends were analyzed with nonparametric statistics and Statistical Process Control p-charts.
Results:
Of 2,458 eligible patients, 2,062 who delivered vaginally were analyzed (396 intrapartum cesarean deliveries excluded). All three primary quality drivers scores improved significantly across the three periods (P < 0.0001). Mean overall quality driver scores increased from 4.31 to 4.38 at baseline to 4.99 in Year 2. The proportion of low-quality driver events (score < 4) declined from 3.45% to < 0.4% by Year 2. Statistical Process Control p-charts demonstrated sustained process stabilization.
Conclusions:
A structured quality improvement program integrating monthly audit-feedback cycles, Statistical Process Control monitoring, and Pareto-driven root-cause analysis was associated with sustained improvements in labor epidural analgesia quality and maternal satisfaction.
