Clinical pathways have spread over hospitals in Japan in recent years. However, most clinical pathways remain at the initial stage and many hospitals feel it difficult to advance into the variance analysis. lt is indispensable to clarify the necessary data and its application for the variance analysis in order to develop the clinical pathways from the frrst stage to the second stage.

　In this research, we examined in detail all the contents of the medical records for 100 patients to whom the breast surgery clinical pathway was applied, aiming to clarify the source of the problem in the clinical pathway practice. As a result, the variance judgment for 100 patients by their nurses was that “no variance” is 79, “change” is 6, “deviation” is O, “dropout” is 4, and “variance level is not described” is 11. ln contrast, the variance for them decided by our detailed examination on the medical records was that “novariance” is 7, “change” is 84, “deviation” is 5, and “dropout” is 4.

　It was found that such a difference arose from the biased variance judgment toward the complications, the obscure treatment of the clinical pathway in the medical records, and the vague variance criteria and outcome settings. These findings suggest methods and education useful for continuing the process consist of variance collection, variance analysis and review of medical care in the clinical pathway.