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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.
A peer-led quality improvement initiative significantly reduced practice variability in obstetric anesthesia. This approach standardized care using Society for Obstetric Anesthesia and Perinatology (SOAP) recommendations, demonstrating a reproducible model for clinical practice.
Area of Science:
- Obstetric Anesthesia
- Quality Improvement
- Healthcare Standardization
Background:
- Practice variability in obstetric anesthesia persists despite evidence-based guidelines.
- Standardizing care in clinical settings presents challenges for obstetric anesthesia teams.
- A peer-led implementation strategy based on Society for Obstetric Anesthesia and Perinatology (SOAP) benchmarks was proposed to reduce variability.
Purpose of the Study:
- To evaluate the effectiveness of a peer-led implementation process in reducing practice variability in obstetric anesthesia.
- To assess the adoption of Society for Obstetric Anesthesia and Perinatology (SOAP) recommendations within a new obstetric anesthesia team.
- To determine if structured meetings and a digital tool can standardize care.
Main Methods:
- Prospective quality improvement project involving 21 anesthesiologists in a tertiary-care hospital.
- Implementation included weekly peer-led meetings and development of a digital pocket guide.
- Focused on four key areas: spinal needle, labor analgesia, intrathecal adjuvants, and vasopressor strategy.
Main Results:
- High adoption rates (76.2% survey response) for standardized practices.
- Complete adoption achieved for spinal needle selection, labor analgesia solution, and intrathecal adjuvants.
- Significant increase in programmed intermittent epidural bolus (93.75%) and prophylactic norepinephrine infusion (93.75%).
Conclusions:
- A 10-month quality improvement initiative successfully achieved near-complete practice standardization at minimal cost.
- The peer-led approach, incorporating SOAP recommendations, provides a reproducible template for institutional practice.
- Residual barriers included technical confidence, interprofessional resistance, and logistical challenges.