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Reducing practice variability in obstetric anesthesia through a structured, team-based implementation strategy: a
Eliane Cristina de Souza Soares1, Paulo Carvalho Pimenta Figueiredo2, Felipe Ribeiro da Silva Camargos1
1Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte, Minas Gerais CEP 30130110, Brazil; Grupo SAM - Rede Mater Dei de Saúde, Alameda Oscar Niemeyer, 61, Vila da Serra, Nova Lima, Minas Gerais CEP 34006065, Brazil.
Background:
Practice variability in obstetric anesthesia remains common despite evidence-based recommendations, and standardizing care may be challenging in clinical practice settings. We hypothesized that a peer-led implementation process grounded in Society for Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence benchmarks recommendations, combining structured weekly meetings and a co-authored digital reference tool, could achieve clinically meaningful reductions in self-reported practice variability within a newly established obstetric anesthesia team.
Methods:
This prospective quality improvement project was conducted in a tertiary-care private hospital in Brazil between February and December 2025, with 21 anesthesiologists providing obstetric anesthesia care. This implementation project comprised five steps, including weekly peer-led meetings to build consensus on institutional practice and address components identified as having the highest pre-intervention variability. These were identified to be the spinal needle used for cesarean delivery, neuraxial labor analgesia technique and solutions, intrathecal adjuvants for cesarean delivery, and vasopressor strategy for spinal-induced hypotension. After selecting these four practices for the intervention, a digital pocket guide was developed. A 20-question survey collecting self-reported practice changes was distributed post-intervention, and the primary outcome was self-reported adoption of team-agreed clinical practices.
Results:
The response rate to the survey was 76.2%. Complete adoption was reported for spinal needle selection, labor analgesia solution, and intrathecal adjuvants for cesarean delivery. Programmed intermittent epidural bolus analgesia use increased from 6.25% to 93.75%, and prophylactic norepinephrine infusion was adopted by 93.75%. Residual barriers included technical confidence, interprofessional resistance, and logistical difficulty.
Conclusions:
This quality improvement initiative achieved near-complete self-reported practice standardization within 10 months at minimal cost, offering a reproducible template for translating SOAP recommendations into institutional practice.