Authors: Patel S S et al.
Journal: Cureus 17(12): e98450, DOI: 10.7759/cureus.98450
Summary
This article proposes a standardized quality improvement framework for neuraxial labor analgesia in obstetric anesthesia. Because quality metrics for epidural and combined spinal-epidural techniques vary widely between institutions, the authors synthesized national guidance and expert opinion to create a uniform, procedure-specific benchmarking system.
A targeted review of guidelines, peer-reviewed studies, and gray literature was conducted. A multidisciplinary panel of anesthesiologists, residents, CRNAs, and CAAs then refined the metrics through consensus. The final framework identifies five major domains.
Access and timeliness focus on rapid availability of neuraxial labor analgesia, recommending that at least 90% of eligible patients receive analgesia within 30 minutes of request. Safety metrics include dural puncture rates below 1%, epidural replacement rates below 5%, maternal hypotension requiring vasopressors under 10%, and zero tolerance for high neuraxial block or epidural-related infection or hematoma. Effectiveness benchmarks include adequate pain relief within 20 minutes in at least 95% of patients and conversion to general anesthesia for cesarean delivery below 1%.
Documentation standards require complete procedure notes, checklist use, and pre-/post-procedure pain scores in at least 95% of cases. Patient experience benchmarks include at least 90% satisfaction and at least 95% willingness to receive neuraxial analgesia again. By consolidating these metrics into a single dashboard, institutions can align expectations, benchmark performance, and promote continuous improvement.
What You Should Know
• The paper creates a unified quality framework specifically for obstetric neuraxial anesthesia.
• Five domains are emphasized: access/timeliness, safety, effectiveness, documentation, and patient experience.
• Benchmarks include: neuraxial access ≤30 minutes (≥90%), dural puncture <1%, replacement <5%, hypotension <10%, adequate pain relief ≥95%, conversion to general anesthesia <1%.
• Documentation and patient satisfaction targets are very high to support accountability and quality improvement.
• Institutions can use these metrics as a standardized dashboard for comparing performance and improving patient-centered care.
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