Is general inpatient obstetrics and gynaecology evidence-based? A survey of practice with critical review of methodological issues

BACKGROUND To examine the rates of evidence-supported care provided in an obstetrics-gynaecology unit. METHODS The main diagnosis-intervention set was established for a sample of 325 consecutive inpatient admissions in 1998-99 in a prospective study in a UK tertiary care centre. A comprehensive literature search was conducted to obtain the evidence supporting the intervention categorised according to the following hierarchy: Grade A, care supported by evidence from randomised controlled trials; Grade B, care supported by evidence from controlled observational studies and convincing non-randomised evidence; and Grade C, care without substantial research evidence. RESULTS Of the 325 admissions, in 135 (42%) the quality of care was based on Grade A evidence, in 157 (48%) it was based on Grade B evidence, and in 33 (10%) it was based on Grade C evidence. The patterns of care were not different amongst patients sampled in 1998 and 1999. CONCLUSION A significant majority (90%) of obstetric and gynaecological care was found to be supported by substantial research evidence.