Variation in 17 obstetric care pathways: Potential danger for health professionals and patient safety?

Aim. To report a study to determine whether or not variations exist in evidence-based key interventions in pathway documents for normal delivery across hospitals. Background. Care pathways are used worldwide to standardize and follow up patient-focused care. Minimal variations in pathway documents increase standardization and patient safety. Design. A descriptive study design using qualitative methods was used, to examine the various key interventions present in care pathway documents for normal delivery. Methods. Between January-March 2009, we evaluated the content of the care pathway document for normal delivery from 17 different hospitals. The key interventions in these pathways were compared with the 40 evidence-based key interventions of Map of Medicine®. Results. There was much variation in the characteristics and the presence of key interventions in the pathway documents. Only 6 of the 40 evidence-based key interventions (15%) were found in all 17 pathway documents and 20 of the 40 interventions (50%) were found in only 10 pathway documents. Conclusion. If variation already exists among the care pathway documents, this may lead to a high probability of variation in the actual performance of daily care. In this study is shown that, even for highly predictable medical conditions, there are huge differences in the evidence-based content and structure of pathways. Lack of evidence base could potentially endanger both patient safety and the health professional.