Advancing obstetric anesthesia practices in Georgia through clinical education and quality improvement methodologies

Abstract

A structured program of education and quality improvement led to an increase in the use of regional anesthesia for vaginal and cesarean deliveries. Achievements were sustained during periods of economic and political turmoil.

Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

“…The use or RA for CD at the study institutions increased from 20% before their one time, country-wide, multi-institutional intervention to 34% following the program, a rate similar to that reported in year 2015 of the collaboration at CCV. Ninidze et al (10) described better success in their collaboration of yearly program visits over 4 years to five participating hospitals in Georgia, another country with health-care demographics similar to Serbia. The importance of repeated visits over time was emphasized in this study, as the three hospitals who were visited four times reported increases in RA use for CD from approximately 20 to 80%, while the two hospitals visited only twice reported more modest increases from approximately 25 to 50%.…”

“…Obstetricians often have a major influence over patient choice of anesthesia (10). Obstetrician preference may have a larger effect than that of the anesthesiologist in the choice of RA versus GA and efforts directed at obstetrician education to adequately answer patient questions concerning RA may be as important as those directed toward patients in increasing patient acceptance (10). An added benefit is that it may also overcome obstetrician reluctance to RA use (9, 11–13, 15).…”

“…Collaborations between non-governmental global health organizations and host institutions in LMICs have been shown to be effective in increasing obstetric RA use (10–13). One report of a single, short-term effort to teach RA techniques in eight hospitals throughout Croatia reported a 50% increase in use of RA for CD and smaller increases in use of NAL (12).…”

“…Whether these changes were sustained has not been reported. Although single, short-term educational efforts can improve anesthetic performance in some settings, longer collaborative commitments are most often necessary to achieve lasting change (10, 14). Rates of RA use both for CD and labor may regress without ongoing mentoring and support (14).…”

“…Barriers to implementation in such settings are varied. One report from Georgia cited lack of governmental funding for supplies, lack of familiarity of anesthesia staff with current techniques and evidence-based guidelines, and limited availability of appropriate local anesthetics as possible reasons (10). Another survey of RA use from the Czech Republic cited patient fear over the safety of RA and lack of acceptance by obstetric providers (9), similar to a report of an ongoing collaboration in China between Chinese and American anesthesia providers (11).…”