Reducing practice variability in obstetric anesthesia through a structured, team-based implementation strategy: a quality improvement study.

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.