Abstract
BackgroundWe planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care.MethodsObservers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS.ResultsData on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival.ConclusionsInadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel.
Highlights
We planned an observational study to assess obstetric anesthesia services nationwide
In a nationwide survey of all maternity units in Israel performed in 2005 [2], we found that the provision of anesthesia workforce supply to maternity units is often inadequate to meet workload demands and that hospitals with no anesthesiologist dedicated to the maternity unit had longer epidural waiting times, lower rates of epidural analgesia and higher rates of general anesthesia for emergency Cesarean section(s) (CS)
This study aimed to provide objective data to assess the hypothesis that the ability to provide quality and safe obstetric anesthesia services requires adequate workforce allocations
Summary
We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. We aimed to conduct an objective observational snapshot study of the obstetric anesthesia service in Israel’s maternity units in order to assess the effect of the workforce supply to workload demand ratio on outcomes of obstetric care that will affect patient satisfaction and patient safety. We hypothesize that as the ratio of workforce supply to workload demand decreases, that patient satisfaction and patient safety outcomes will deteriorate. There has been both a reduction in anesthesia workforce supply and an increase in anesthesia workload demand over recent years in Israel [1]. The C-section rate has leveled off over the past few years, the number of births have increased (from 136,500 in 2000 to 183,400 in 2017), so that the absolute number of C-sections has increased, so increasing the burden upon anesthesiologists
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