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


K. Vanhaecht: e-mail:


Sarrechia M., Van Gerven E., Hermans L., Deneckere S., Sermeus W., Panella M., Spitz B. & Vanhaecht K. (2012) Variation in 17 obstetric care pathways: potential danger for health professionals and patient safety?. Journal of Advanced Nursing69(2), 278–285. doi: 10.1111/j.1365-2648.2012.06004.x


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.