title: Care pathways in obstetrics: the effectiveness in reducing the incidence of episiotomy in childbirth.
abstract: OBJECTIVE
  To develop a care pathway for childbirth.
  
  
  BACKGROUND
  Care pathways are emerging as an effective tool to improve clinical and organizational performance.
  
  
  METHODS
  A pre- and postimplementation analysis model was used to evaluate the effect of introducing a care pathway for childbirth. Key outcome indicators and costs were reviewed to compare the traditional care processes with those of the care pathway. The study involved 380 women.
  
  
  RESULTS
  There was a significant reduction in episiotomy rate (from 14.90% to 8.6%, P = 0.02) in patients being cared for using a care pathway approach; however, there were no differences in caesarean section and in perineal wound rates. The average costs per patient on the care pathway were euro 1278.42 ( pound 873.64) compared with euro 1,146.87 ( pound 783.74) preimplementation. The study also demon- strated an increase in patient satisfaction for women cared for using the care pathway approach.
  
  
  CONCLUSIONS
  The care pathway proved to be a valid methodological approach to childbirth, allowing healthcare workers to efficiently share the care of the women, guaranteeing safe and effective care.
authors.affiliation: Saint Andrew Hospital, Vercelli, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Marchisio
authors.forename: Karen
authors.initials: K
authors.lastname: Ferraccioli
authors.forename: Antonietta
authors.initials: A
authors.lastname: Barbieri
authors.forename: Alfredo
authors.initials: A
authors.lastname: Porcelli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Panella
mesh_terms: D000328:Adult; D019091:Critical Pathways; D036861:Delivery, Obstetric / Q000191:economics / Q000592:standards*; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016015:Logistic Models; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D018709:Statistics, Nonparametric; D006113:United Kingdom