International journal of obstetric anesthesia · 2026
Neuraxial labor analgesia outcomes in a referral center in Vietnam: a quality improvement program incorporating Statistical Process Control methodology (2022-2024).
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Quach Chinh Minh, Duong Chinh Phuong, Ho Nhan Thi, Macaire Philippe, Lua Clara Christina P E, Ly Hao Phuong, Capdevila Xavier
Аннотация
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.
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.