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Estimating Obstetric Anesthesiology Workload: Number of Deliveries versus Workload Hours per Hour.
Abstract Number: T-38
Abstract Type: Original Research
Introduction: Knowledge of the number of deliveries is utilized to estimate obstetric anesthesiologist workload on labor and delivery (1, 2). However, this number may not reflect true workload for ideal staff planning. The goal of this analysis was to assess if including estimates of procedure-related time commitments would better predict clinical workloads.
Methods: We queried the electronic medical record data at our academic center for 12 consecutive months of maternal deliveries. Data extracted included delivery type, anesthetic/analgesic procedure and whether delivery occurred during weekday (Mon-Fri 7a-5p), weeknight (Mon-Fri 5p-7a) or weekend (Sat 7a-Sun 7a) shifts. To calculate anesthesiology workload hours, delivery type was multiplied by an estimated total dedicated time associated with the anesthetic/analgesic procedure. We estimated 2 hours for cesarean delivery anesthetic and 30 minutes for labor epidural analgesia. To generate an hour to hour comparison of shifts of varying duration, workload hours was divided by the number of hours in each shift.
Results: A total of 4598 deliveries occurred in the 12 month study period, including 1707 during weekdays and 2891 during the weeknights and weekends. The cesarean delivery rate was 31.7% and labor epidural rate was 85%. 1564 anesthetic/analgesic procedures occurred during weekdays and 2557 anesthetic/analgesic procedures occurred during the weeknights and weekends (Fig 1a) including 773 cesarean deliveries during weekdays and 684 during weeknights and weekends. The number of anesthetic/analgesic procedures/hour was 0.60 during weekdays compared to 0.42 during weeknights and weekends. After accounting for the duration of each procedure, weekdays utilized 0.75 workload hours/hour versus 0.38 workload hours/hour on weeknights and weekends (Fig 1b).
Conclusion: Basing relative workload on delivery numbers alone suggests 59% less workload during the weekday compared to weeknight and weekend shifts, whereas accounting for anesthetic/analgesic procedures per hour shows a 42% greater workload during the weekday shifts. Factoring in time of anesthetic/analgesic procedures resulted in a 99% greater workload on weekday shifts. Data from this study shows the importance of considering anesthetic/analgesic procedures and their relative duration to better plan optimal staffing for different shifts on labor and delivery.
1. Anaesthesia. 1999;54(10):958-62.
2. Anaesthesia. 2002;57(5):493-500.