Obstetric and Gynecological Clinic of Bibida, Tbilisi, Georgia.
Int J Gynaecol Obstet. 2013 Mar;120(3):296-300. doi: 10.1016/j.ijgo.2012.09.027. Epub 2012 Dec 23.
To determine whether an integrated program of clinical education and improvement methods regarding the safe use of regional anesthesia for obstetrics would result in improved and sustained practice change in Georgia.
Between 2006 and 2009, intervention teams undertook several visits to 5 Georgian hospitals. Rates of regional anesthesia for labor and cesarean delivery prior to and following the intervention were collected from participating and non-participating hospitals. There were multifaceted educational activities and quality improvement activities at intervention sites, including protocol development, social marketing, and supply chain logistics. Host hospitals evaluated the program via a questionnaire.
The use of general anesthesia for cesarean delivery decreased significantly (P<0.001) and the use of epidural analgesia for labor increased significantly (P<0.001); there was no change in non-participating hospitals. Over the course of the program, medication and supply availability improved. Program evaluations were uniformly positive.
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.
确定针对产科区域麻醉安全使用的临床教育和改进方法的综合计划是否会导致格鲁吉亚实践的改善和持续改变。
在 2006 年至 2009 年期间，干预小组对格鲁吉亚的 5 家医院进行了多次访问。在干预之前和之后，从参与和不参与的医院收集了关于劳动和剖腹产中区域麻醉的比率。干预点有多种教育活动和质量改进活动，包括方案制定、社会营销和供应链物流。主办医院通过问卷评估该计划。
剖宫产全麻使用率显著下降（P<0.001），劳动硬膜外镇痛使用率显著增加（P<0.001）；非参与医院没有变化。在项目实施过程中，药物和供应的可获得性有所改善。项目评估结果一致为正面。
有组织的教育和质量改进计划导致阴道分娩和剖腹产中区域麻醉的使用增加。在经济和政治动荡时期，成就得以持续。
