Prepare to Fail? The impact of developing an institutional protocol on improving confidence in the management of the failing epidural.
Dr Darragh O'Reilly, Kaitlin Nelson MSc, Dr Jonathan Collins, Dr Clare Burlinson

SLIDE 1

Pre/Post-Intervention Study · Education · Neuraxial Labour Analgesia

Background

• Epidural analgesia is used by 73% of parturients; failure rates reach up to 25%
• Management has traditionally relied on expert opinion and clinical experience — lacking structured guidance for junior providers
• ESAIC guidelines recommend institution-specific protocols with example algorithms

Hypothesis

• The introduction of an institutional protocol based on ESAIC guidelines will improve resident confidence in managing the failing epidural

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SLIDE 2

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SLIDE 3 — Study Overview: Methods & Results

METHODS

Study Design

• Pre/post-intervention study
• Residents stratified: junior vs. senior

Intervention

• Locally developed failing epidural algorithm
• Based on ESAIC guidelines, local practice & expert consultation

Survey & Analysis

• 21 questions, 5-point Likert scale
• Troubleshooting scenarios & non-technical factors
• Descriptive: means & frequency, pre vs. post

RESULTS

Full Cohort (n=36 pre → n=25 post)

• Improved confidence in all domains bar one neutral result
• Exception: low block — neutral (mean 4.08/5)
• Resource awareness: +1.22/5 (2.74 → 3.96)

Subgroup Analysis

Junior

• Improved across most domains
• Unilateral block: mean +0.72/5

Senior cohort

• Sacral sparing: mean +1.21/5
• 50% → 100% very/extremely confident

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SLIDE 4 — Conclusion & Discussion

• Education: Using our guideline during targeted teaching increased residents' confidence in managing failing epidurals.
• Senior residents improved less — likely due to greater clinical experience at baseline and informal bedside teaching during junior rotations.
• Our results support using structured, algorithm-based teaching tailored to the institution.
• We hope this work contributes to improving overall epidural analgesia quality and patient experience.