Measuring obstetric anaesthesia workload : empirical research using a mixed methods design as part of a quality and safety improvement project

Abstract

BACKGROUND: Obstetric anaesthetists at Mater Dei Hospital considered the quality and safety of their work was deteriorating due to increasing workload. Literature suggests various ways of measuring this including the delivery rate, caesarian section rate, epidural rate, the obstetric anaesthesia activity index or a combination. The Objectives were: to define the obstetric anaesthesia workload; to benchmark to standards set by international bodies; and to make evidence-based recommendations to improve safety and quality.

METHODS: This single-centre study was performed between September 24 and November 20, 2017. It was an empirical research study using a mixed methods design. This allowed for data triangulation. Data was analyzed using SPSS.

RESULTS: In 58 days, there were 669 births, 198 (29.6%) of which were by a lower segment Caesarean section (LSCS). On 30 days (52%), elective work over-ran, adding to the on-call workload. Average theatre cases in 24-hours were 3.81 ± 1.55. Epidural rate was 28.4% (n=190). The mean number of epidurals in a 24-hour period was 3.28 ± SD1.609. On 7 days (12%), not all requested epidurals were done because the anaesthetist was busy. Significant 'hidden workload' was identified including patient reviews on 39 days (67%), vascular access outside theatre on 21 days (36%) and stand-by requests on 29 days (50%). There was no statistically significant difference between the work done on weekdays versus weekends.

CONCLUSIONS: We identified a significant amount of “hidden workload” in obstetric anaesthesia and workflow inefficiencies. Recommendations are being implemented to increase quality and safety of obstetric anaesthesia in Malta.