Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Department of General and Oncological Surgery - Surgery C, The Haim Sheba Medical Center, Ramat Gan, Israel.
Isr J Health Policy Res. 2021 Mar 15;10(1):24. doi: 10.1186/s13584-021-00460-2.
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.
Observers 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.
Data 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.
Inadequate 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.
我们计划进行一项观察性研究，以评估全国的产科麻醉服务。我们旨在评估麻醉工作量/劳动力比率对产科麻醉护理质量和安全结果的影响。
观察者在 72 小时内（星期三、星期四和星期五）从分娩单位前瞻性收集数据。自变量是工作量（WL）和劳动力（WF）。工作量通过产科麻醉活动指数（OAAI）评估，这是在 24 小时内用于硬膜外和所有剖宫产的估计时间。劳动力（WF）通过每周专门用于分娩病房的麻醉师人数评估。因变量是硬膜外麻醉师到达的时间（质量指标）和紧急剖宫产（CS）时全身麻醉的发生（安全指标）。这项普查包括阴道分娩和非计划（但非选择性）CS。
仅来自 12 个产科单位的 575 次分娩的数据，主要是因为一家主要的医院连锁店选择不参与；其他 8 家医院缺乏机构审查委员会的批准。硬膜外反应率为 94.4%；340 名要求硬膜外镇痛（EA）的产妇中有 321 名接受了 EA。19 名要求 EA 但未分娩的产妇中，有 14 名（77%）是由于麻醉师延迟到达。麻醉师到达的中位等待时间从 5 分钟到 28 分钟不等。产科麻醉活动指数从 4.6 到 25.1 不等，WF 从每班 0 到 2 不等。在主要服务正统犹太社区的医院和偏远医院，EA 的请求率与整个样本相似。超过五分之一（13/62；21%）的非计划 CS 接受了全身麻醉，其中近四分之一（3/13；23%）归因于麻醉师延迟到达。
劳动力分配不足可能会影响产科麻醉服务的质量和安全结果。OAAI 是工作量的更好预测指标，而不仅仅是分娩次数，尤其是在劳动力短缺的情况下。为了评估全国分娩单位麻醉服务的质量和安全性，应在以色列所有分娩单位前瞻性收集劳动力、工作量和临床结果的观察数据。
