TITLE

Reducing Practice Variability in Obstetric Anesthesia
A structured, team-based implementation of SOAP Centers of Excellence recommendations in a private hospital

Eliane Soares · Paulo Figueiredo · Fabiano Carneiro · Ruth Landau

BACKGROUND & HYPOTHESIS

• Practice variability exists in obstetric anesthesia
• Implementation of SOAP Centers of Excellence (SOAPCOE) recommendations may reduce variability
• Structured, team-based processes may facilitate behavioral change

METHODS

How we did it

• 30-minute weekly online meetings (February to December 2025)
• SOAPCOE recommendations used as framework
• Team members led each topic
• Open debate → Consensus → Pocket guide
• In situ training + obstetric team meeting
• Informal discussions and active feedback (e.g., coffee breaks)
• Anonymous electronic survey after 11 months

Study design approach

Participants answered:

1. What did you use to do? (Jan 2025)
2. What was the meeting decision?
3. What do you do now? (Dec 2025)

Who are we

• L&D Unit – September 2024
• 21 anesthesiologists (11 men, 10 women)
• Mean age: 39.8 years (26–73)
• Mean anesthesia experience: 9.6 years (3–45)
• Mean OB anesthesia experience: 8.5 years

RESULTS

Overall adoption

• 76.2% completed the survey
• All respondents correctly identified the agreed recommendations

Practice changes after 11 months

Spinal needle choice

• Before: 87.5%
• After: 100%
• Quincke needles eliminated

Labor analgesia

• Before: 6.7%
• After: 93.8%
• Adoption of PIEB + PCEA
• Ropivacaine 0.1% + fentanyl universally adopted

C-section adjuvants

• Before: Variable
• After: 100%
• Intrathecal morphine + fentanyl/sufentanil

Vasopressor strategy

• Before: Bolus PRN (ephedrine, metaraminol, phenylephrine)
• After: 81.3%
• Prophylactic norepinephrine infusion
• Selected to avoid maternal bradycardia

Barriers identified

• Lack of confidence in PIEB use
• Occasional resistance from obstetricians

DISCUSSION

Key findings

• SOAPCOE framework provided scientific credibility and facilitated consensus
• Pocket guide reduced inter-individual variability
• Behavioral change reinforced by ongoing informal discussions and feedback

NEXT STEPS

• Audit medical records
• Continue structured process for remaining SOAPCOE topics

CONCLUSION

Team-based structured meetings and SOAP COE framework successfully standardized obstetric anesthesia practice in a private Brazilian hospital