Correspondence| Volume 53, 103615, February 2023

Download started.


Challenges with quality improvement in obstetric anaesthesia: playing the long game

Published:December 05, 2022DOI:
      Persistent postpartum pain affects 6.1–11.5% of women with risk factors that include caesarean section (CS) and severe acute postoperative pain.
      • Lavand’homme P.
      Postpartum chronic pain.
      Since 2009, our department has completed five cycles of quality improvement concerning post-CS analgesia, a key audit standard recommended by the Royal College of Anaesthetists.

      Armstrong S. Pain relief after caesarean section. Raising the Standards: RCoA Quality Improvement Compendium. 2020. Accessed 7 June, 2022.

      We present possible reasons for success and discuss theories for those areas with slower rates of improvement, with a particular focus on patient safety and challenges faced within maternity departments and in obstetric anaesthesia.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lavand’homme P.
        Postpartum chronic pain.
        Minerva Anestesiol. 2019; 85: 320-324
      1. Armstrong S. Pain relief after caesarean section. Raising the Standards: RCoA Quality Improvement Compendium. 2020. Accessed 7 June, 2022.

        • Roofthooft E.
        • Joshi G.P.
        • Van de Velde M.
        PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific post-operative pain management recommendations.
        Anaesthesia. 2021; 76: 665-680
        • Backhouse A.
        Quality improvement into practice.
        BMJ. 2020; : 368
        • Dixon-Woods M.
        • McNicol S.
        • Martin G.
        Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature.
        BMJ Qual Safe. 2012; 21: 876-884
        • Liberati E.
        • Peerally M.F.
        • Dixon-Woods M.
        Learning from high risk industries may not be straightforward: a qualitative study of risk controls approach in healthcare.
        Int J Qual Health Care. 2018; 30: 39-43
        • Gurses A.P.
        • Ozok A.A.
        • Pronovost P.J.
        Time to accelerate integration of human factors and ergonomics in patient safety.
        BMJ Qual Safe. 2012; 21: 347-351
        • Scott S.
        • Cameron S.
        • Richards E.
        Maternal administration of oral analgesia after caesarean section.
        Anaesthesia. 2001; 56: 906-924
        • Bishop D.G.
        • Gibbs M.W.
        • Dyer R.A.
        Post-caesarean delivery analgesia in resource-limited settings: a narrative review.
        Int J Obstet Anesth. 2019; 40: 119-127
        • Coleman J.J.
        • Hodson J.
        • Brooks H.L.
        • Rosser D.
        Missed medication doses in Hospitalised patients: a descriptive account of quality improvement measures and time series analysis.
        Int J Qual Health Care. 2013; 25: 564-572