Obtaining Excellence in Obstetric Anesthesia

  • Zakowski, Mark, MD
  • Carvalho, Brendan, MBBCh, FRCA, MDCH
| Jul 26, 2021

Carvalho B 2020 (002)ZakowskiMost clinicians, departments and hospitals aim to achieve excellence in clinical care, as well as education and research/scholarship in academics. There are common measures to assess educational and research/scholarship abilities including trainee evaluations, talks/presentation feedback, publications, grants and research awards.  However, clear metrics for individuals, departments or institutions to achieve excellence in anesthesia clinical care are often lacking.

Fortunately, an opportunity to evaluate clinical care in obstetric anesthesia at institutions now exists. In 2018, the Society for Obstetric Anesthesia and Perinatology (SOAP) launched the Centers of Excellence for Anesthesia Care of Obstetric Patients. This designation was introduced to recognize institutions and programs that demonstrate excellence in obstetric anesthesia care, to provide a blueprint for assisting institutions wanting to improve their clinical care, to set a benchmark level for best practices in obstetric anesthesia care, and to provide a broad surrogate quality metric of institutions providing obstetric anesthesia care. (Carvalho B, Mhyre JM. Centers of Excellence for Anesthesia Care of Obstetric Patients. Anesth Analg. 2019;128(5):844-846)

The criteria for SOAP Centers of Excellence designation covers several domains including personnel and staffing; equipment/protocols/policies; cesarean delivery management; labor analgesia care; implementations of recommendations and guidelines; and quality assurance/patient follow-up systems. The criteria for Centers of Excellence designation covers most aspects of obstetric anesthesia care, and was generated by expert consensus that incorporate evidence-based recommendations. The designation provides three metrics that need to be achieved:

  • General anesthesia for cesarean delivery (ideally <5%)
  • Labor epidural block replacement rate (ideally 3-6%)
  • Post-dural puncture headache rate of <2%

All these metrics require evidence of ongoing quality assurance reviews and continuing efforts to improve these measures.

The benefits of SOAP Centers of Excellence designation include attaining national recognition/validation for excellence in obstetric anesthesia care; meeting the criteria for American College of Obstetricians and Gynecologists (ACOG) Levels of Maternal Care; obtaining a public relations, faculty recruitment and marketing award; demonstrating quality of clinical care provision; and potentially allowing for additional group/departmental revenues negotiations and/or reducing medicolegal costs. To date, 70 centers have obtained the SOAP Centers of Excellence designation around the world. Of the 62 centers in the United States, 12 centers are in California (Table) making California the state with the most SOAP Centers of Excellence. The SOAP Centers of Excellence is a 4-year designation, and the annual application cycle is currently open until September 2021. For more details go to https://www.soap.org/centers-of-excellence_program

Beyond obstetric anesthesia, more initiatives are needed to better outline excellence in anesthesia care. National societies should lead such initiatives to evaluate and/or reward individuals, departments or institutions that attain excellence in clinical care. The CSA should play a key role in improving clinical anesthesia care in California by advocating for recognition and support of clinical excellence, providing support for excellence in anesthesia care blueprints to help guide institutions to attain these requirements, and outlining processes for these domains and metrics to be evaluated.

Table: Current Society for Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence for Anesthesia Care of Obstetric Patients in California (in order of designation):


  Stanford University

  Saddleback Memorial Medical Center

  University of California San Francisco

  Sharp Mary Birch Hospital for Women and Newborns

  Zuckerberg San Francisco General Hospital and Trauma Center

  Cedars-Sinai Medical Center


  Kaiser Permanente – Roseville

  Miller Women's and Children's Hospital


  Hoag Memorial Hospital Presbyterian

  Loma Linda University 

  Sutter Medical Center - Sacramento

  UC Davis Medical Center

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