title: Advancing obstetric anesthesia practices in Georgia through clinical education and quality improvement methodologies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Obstetric and Gynecological Clinic of Bibida, Tbilisi, Georgia.
authors.forename: Nino
authors.initials: N
authors.lastname: Ninidze
authors.forename: Sarah
authors.initials: S
authors.lastname: Bodin
authors.forename: Thomas
authors.initials: T
authors.lastname: Ivester
authors.forename: Lisa
authors.initials: L
authors.lastname: Councilman
authors.forename: Brittany
authors.initials: B
authors.lastname: Clyne
authors.forename: Medge
authors.initials: M
authors.lastname: Owen
mesh_terms: D000765:Anesthesia, Conduction / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000706:statistics & numerical data; D000773:Anesthesia, Obstetrical / Q000379:methods* / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005846:Georgia (Republic); D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D015397:Program Evaluation; D058996:Quality Improvement / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires