Development of an obstetric anesthesia needs assessment framework to inform quality improvement: a pilot evaluation in a high-volume maternity hospital in Vietnam.

BACKGROUND: Maternal mortality rates in Vietnam and other low- and middle-income countries have remained stagnant over the past decade, suggesting opportunity for improvement in maternal care. Obstetric anesthesiologists are uniquely poised to enhance maternal outcomes. This study aimed to develop a needs assessment framework to identify and guide priorities for future quality improvement interventions at a high-volume maternal hospital in Hanoi, Vietnam. METHODS: An obstetric anesthesia needs assessment quality improvement framework was developed through an iterative and collaborative process, represented by three phases (pre-on-site, on-site, post-on-site visit). The final mixed-methods survey, disseminated to all hospital staff, included the following categories: maternal care, anesthesia capacity, maternal risk assessment and morbidity tracking, quality improvement initiatives, open-ended responses. RESULTS: A total of 1268 responses were analyzed. Respondents were predominantly in clinical roles (57%). Access to anesthesia providers for neuraxial procedures (66.4%) and use of safety checklists and protocols (90%) was high. Systems for maternal morbidity and mortality tracking were reported as inconsistently utilized (71.8%). Barriers included financial constraints (39%) and lack of interest (33.1%). Respondents considered outcome tracking important (74%), yet only 68.3% reported awareness of the institution's leading causes of maternal morbidity and mortality. CONCLUSIONS: We developed and piloted a structured obstetric anesthesia-led needs assessment framework capable of identifying locally supported priorities for future quality improvement initiatives with the aim of enhancing maternal safety. Further evaluation of the framework's transferability and scalability across diverse low- and middle-income countries' health systems is needed.