Standardizing Quality Metrics for Neuraxial Labor Analgesia: A Quality Improvement Framework for Obstetric Anesthesia

Abstract

Neuraxial labor analgesia, delivered through epidural or combined spinal-epidural techniques, remains the cornerstone of intrapartum pain management. However, variation in quality measurement continues to limit opportunities for benchmarking and systematic improvement. This study aimed to synthesize existing quality measures and propose a standardized obstetric anesthesia quality improvement framework with clear, measurable benchmarks. A targeted review was conducted using predefined inclusion and exclusion criteria to identify organizational guidelines, peer-reviewed literature, and gray literature sources relevant to neuraxial labor analgesia quality metrics, which were then refined through expert consensus. A multidisciplinary panel consisting of attending anesthesiologists, anesthesiology residents, certified registered nurse anesthetists (CRNAs), and certified anesthesiologist assistants (CAAs) reviewed the synthesized evidence, and all benchmarks were finalized through structured discussion and consensus-based decision-making. The resulting framework outlines proposed operational benchmarks across five domains. Access and timeliness were defined as at least 90% of eligible patients receiving neuraxial analgesia within 30 minutes of request, with a median request-to-placement time of 30 minutes or less. Safety metrics included dural puncture rates below 1%, epidural replacement below 5%, maternal hypotension requiring vasopressors below 10%, and elimination of high neuraxial block or epidural-related infection/hematoma as sentinel events. Effectiveness measures targeted adequate pain relief within 20 minutes in at least 95% of cases and conversion to general anesthesia for cesarean delivery below 1%. Documentation and compliance required complete procedural records, checklist use, and pre- and post-procedure pain scores in at least 95% of cases. Patient experience benchmarks included at least 90% satisfaction with pain management and 95% willingness to choose neuraxial analgesia again. Benchmark thresholds were informed by published evidence, national and international recommendations, findings across included sources, and expert consensus. A consolidated, procedure-specific dashboard can align practice expectations, enable transparent benchmarking, and drive continuous improvement. Adoption of this framework can standardize measurement and promote high-quality, patient-centered obstetric anesthesia care.

Keywords: benchmark; dashboard; obstetric anesthesia; quality improvement research; quality metric.

Figure 1. Methodological workflow for framework creation

ASA: American Society of Anesthesiologists; SOAP: Society for Obstetric Anesthesia and Perinatology; CMS: Centers for Medicare and Medicaid Services; AHRQ: Agency for Healthcare Research and Quality Infographic designed by Nadiya A. Persaud on Canva (Canva Inc., Perth, Australia)