title: Comparison of the obstetric anesthesia activity index with total delivery numbers as a single denominator of workload demand in Israeli maternity units.
abstract: BACKGROUND
  Obstetric 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  This 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.
  
  
  CONCLUSIONS
  As 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Ginosar
authors.affiliation: Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Ioscovich
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Charles
authors.initials: C
authors.lastname: Weissman
authors.affiliation: Hebrew University, Hadassah School of Public Health, Jerusalem, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Calderon-Margalit
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Weiniger