title: Important variations in the content of care pathway documents for total knee arthroplasty may lead to quality and patient safety problems.
abstract: OBJECTIVE
  Reducing variations by standardizing the key interventions in clinical processes is an effective tool to minimize the probability of medical errors. Thus, we determined whether variations exist in the key interventions included in care pathway documents (CPDs) of different organizations and in the timing of these interventions during the care process.
  
  
  METHODS
  We invited members of the Belgian Dutch Clinical Pathway Network to send their CPDs for external review. We analysed 19 CPDs for total knee arthroplasty. International guidelines were consulted for definition of key interventions. Documentation of these interventions in the pathway documents was checked.
  
  
  RESULTS
  From the 19 CPDs analysed, we retrieved 18 key interventions. Nine of these key interventions appeared in at least 80% of the care pathways. Only two key interventions appeared in all pathway documents. Nine out of 12 interventions that appeared in at least 80% of the pathway documents showed a variation of 1 day in the timing of care from the median timing.
  
  
  CONCLUSIONS
  We conclude that important variation exists in the included interventions and in their timing. The results of this study suggest that, before use in daily patient care, CPDs should be reviewed by peers and checked to ensure that all evidence-based key interventions are included and properly planned. Only in this way can pathways documents be used interprofessionally during the entire perioperative period in the search for optimal quality and patient safety.
authors: Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors: Olivier
authors: O
authors: Segal
authors: Johan
authors: J
authors: Bellemans
authors: Eva
authors: E
authors: Van Gerven
authors: Svin
authors: S
authors: Deneckere
authors: Massimiliano
authors: M
authors: Panella
authors: Walter
authors: W
authors: Sermeus
authors: Kris
authors: K
authors: Vanhaecht
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards; D004282:Documentation; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D061214:Patient Safety; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors