Comparison of the obstetric anesthesia activity index with total delivery numbers as a single denominator of workload demand in Israeli maternity units

Abstract

BackgroundObstetric anesthesia workload demand in Israel has increased due to both an increase in the requests for labor analgesia and a marked increase in the cesarean delivery rate. We propose a new workload-driven performance indicator, the Obstetric Anesthesia Activity Index (OAAI), to serve as a single denominator of obstetric anesthesia activity to enable direct comparison of different hospitals despite dissimilar rates of epidural labor analgesia and cesarean delivery.MethodsWe performed a secondary analysis of two recent national surveys by the Israel Association of Obstetric Anesthesia. In 2005 and 2007 questionnaires were sent to all Israeli hospitals requesting information on the total numbers of deliveries, epidurals, and cesareans annually, together with the anesthesia workforce allocated for the provision of obstetric anesthesia services. The OAAI was calculated based on the premise that epidurals and cesareans are the predominant determinants of obstetric anesthesia workload and that a typical epidural takes about half the time of a typical cesarean. Accordingly, the OAAI for each hospital was calculated as ((0.75 * number of epidurals per year) + (1.5 * number of cesareans per year))/365.ResultsThis secondary analysis assessed the 25 maternity units in Israel that participated in both the 2005 and 2007 surveys. As expected, there was a wide inter-hospital variability in epidural and cesarean rates. Hospital rankings based on annual delivery numbers were different from those based on the OAAI. The OAAI correlated closely both with the number of epidurals (2005: Pearson 0.97, p < 0.0001; 2007: Pearson 0.97, p < 0.0001) and cesareans (2005: Pearson 0.94, p < 0.0001; 2007: Pearson 0.92, p < 0.0001). These correlations were better for the OAAI than for the annual delivery numbers.ConclusionsAs there was such a wide range of demand for different obstetric anesthesia services among different hospitals, the total number of deliveries is a poor summary indicator of obstetric anesthesia workload. The calculated OAAI better reflected the obstetric anesthesia workload as a single denominator of activity.

Israeli survey of anesthesia practice related to placenta previa and accreta

“…[19][20][21] Two experienced obstetric anesthesiologists (AI and CFW) devised the questions for the survey. Using hospital data sourced from the Israel Society of Maternal Fetal Medicine (ISMFM), we identified anesthesiology unit directors of labor and delivery services in all Israeli medical centers that have an intensive care unit.…”

“…Our survey was conducted through the Israel Association of Obstetric Anesthesiology which has reported high response rates for previous surveys. [19][20][21] Two experienced obstetric anesthesiologists (AI and CFW) devised the questions for the survey. The survey underwent face validation by testing on non-obstetric senior anesthesia colleagues in one institution for comprehensibility and reliability.…”

Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand

“…It has been long recognized that apart from the provision of adequate pain relief on request, that epidural analgesia in labor has also made an important contribution to the safety of mothers and babies during labor. This is because a functioning epidural catheter can be rapidly used for the provision of epidural anesthesia for urgent cesarean delivery avoiding the need for emergent general anesthesia [ 7 ]. General anesthesia is associated with a 10-fold higher risk of airway complications among women undergoing cesarean delivery than among non-obstetric patients [ 8 ].…”

“…The risk of maternal death from complications of general anesthesia is 17 fold higher than that associated with regional anesthesia [ 10 ]. Hence regional anesthesia is the standard of care for cesarean delivery [ 7 ]. Recognition of the risks to the mother associated with general anesthesia has led to an increased use of spinal and epidural anesthesia for both elective, urgent and most emergency cesarean deliveries [ 9 ].…”

“…This practice change may be related to the decrease in anesthesia-associated maternal mortality from 4.3 to 1.7 per 1 million live births in the United States [ 11 ]. Part of the accepted role of the obstetric anesthesiologist is to identify important risk factors for anesthesia (such as physical signs predicting a difficult intubation, a diagnosis of pre-eclampsia and concomitant morbid obesity), and so pre-emptively offer epidural analgesia early in the course of labor [ 7 ]. This is particularly important where there are signs of impending urgent or emergent cesarean delivery (such as poor progress in labor, with variable decelerations in fetal heart rate).…”