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

Israel Journal of Health Policy Research

Eshel A. Nir¹  Yehuda Ginosar²  Alexander Ioscovich³  Gal Schtrechman-Levi⁴  Jacob Hart⁵  Jacob Bar⁶  Ronit Calderon-Margalit⁷ 

[1] Department of Anesthesia and Operating Rooms, Kaplan Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel;Department of Anesthesiology and Critical Care Medicine, and Wohl Institute of Translational Medicine, Hadassah-Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel;Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA;Department of Anesthesiology, Perioperative Medicine, and Pain Treatment, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel;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;Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel;Health Services Management School, Netanya Academic College, Netanya, Israel;Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel;Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel;

关键词: Obstetric anesthesia;    Health service;    Workload;    Workforce;    Epidural analgesia;    Cesarean section;   

DOI  :  10.1186/s13584-021-00460-2

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY