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"apellidos" => "Torres Morera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935619302142" "doi" => "10.1016/j.redar.2019.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619302142?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300329?idApp=UINPBA00004N" "url" => "/23411929/0000006700000003/v2_202004050640/S2341192920300329/v2_202004050640/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "What is the impact of «Do not do» recommendations in a hospital surgical department?" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "176" "paginaFinal" => "177" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Luis Zambrana-Luque, Almudena Sánchez-Benítez, Juan Rodríguez-Galán, José Luis Zambrana-García" "autores" => array:4 [ 0 => array:3 [ "nombre" => "José Luis" "apellidos" => "Zambrana-Luque" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Almudena" "apellidos" => "Sánchez-Benítez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Juan" "apellidos" => "Rodríguez-Galán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "José Luis" "apellidos" => "Zambrana-García" "email" => array:1 [ 0 => "jlzambrana@ephag.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Coordinación Asistencial, Hospital de Montilla, Montilla, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesia, Hospital de Montilla, Montilla, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Línea de Diagnóstico por la Imagen, Hospital de Montilla, Montilla, Córdoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cuál es el impacto de la implantación de recomendaciones «No hacer» en un bloque quirúrgico hospitalario?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2013, the Ministry of Health launched the initiative “Commitment to the quality in Scientific Societies in Spain” with the main aim of reducing the use of unnecessary health interventions, i.e., non-priority interventions that are not cost-effective, have no proven efficacy, and minimal or questionable effect.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the case of the Spanish Society of Anaesthesiology, the Ministry selected 5 “Don’t do” recommendations, including: 1) Do not perform preoperative chest radiography in patients under 40 years of age with ASA I or II physical status, and 2) Do not systematically perform preoperative tests in cataract surgery, unless indicated based on clinical history and physical examination.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Seven years on, few investigators have evaluated the impact of these recommendations on daily practice. This prompted us to undertake a study to analyse the impact of these 2 recommendations in the surgical block of a local hospital.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The Hospital de Montilla Montilla, Cordoba is a public hospital attending a population of approximately 64,000 individuals. Our staff includes 6 doctors specialized in anaesthesiology and critical care. Our hospital performs around 3100 surgeries per year, of which around 60% correspond to major outpatient surgery, 18% to scheduled surgery, and the rest to minor surgery. In 2015, we raised awareness of the “Don’t do” initiative in our hospital by holding a clinical session in the anaesthesiology service, putting the documentation and references at the disposal of our staff, and including the “Don’t do” objectives in our management contract. We conducted an observational, retrospective study in all patients undergoing in-hospital scheduled surgery or major outpatient surgery between 2017 and 2018 and collected data on the number of preoperative tests performed, and the number of chest radiographs performed in patients under 40 years of age, with ASA status I or II, and the reason for such radiographs. The results are expressed as the absolute number of surgeries by specialty in 2017 and 2018, and the number of radiography studies performed in patients under 40 years in both periods. The study was approved by our hospital’s Ethics Committee.</p><p id="par0015" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows our results. A total of 2101 scheduled surgeries were performed in 2017, and 2218 in 2018. We observed a 1% decrease in the number of preoperative studies performed, mainly in ophthalmology −7%), with little change in other specialties. Twenty three studies in patients under 40 years with ASA status I or II were considered unnecessary in 2017 (3.5% of the total) compared to 3 in 2018 (−3.1%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Our results show that raising awareness among anaesthesiologists of the “Don’t do” recommendations successfully reduced the number of unnecessary studies. The practice of performing chest radiographs in patients under 40 years with no lung disease has been practically eliminated, although the overall reduction in preoperative studies has been more modest, and mostly limited to ophthalmology. These results are not as satisfactory as we had hoped. We believe the main reasons for this poor response has been unwillingness to accept certain recommendations, unwillingness to change standard practices, a desire to avoid litigation for alleged negligence or malpractice, and the relative short interval between the 2 measurements.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There is scant mention in the literature on the impact of the "Don’t do" recommendations on clinical practice. Early trends in some of the few studies published have shown that such campaigns have a modest effect on the number of radiological and cardiological tests performed, while other types of diagnostic and therapeutic interventions actually increased.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In Spain, studies in the context of laboratory studies have observed a 19% reduction in testing following awareness raising campaigns.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, active dissemination of “Don’t dos” among anaesthesiologists effectively reduces unnecessary testing, although more time and other actions are probably needed to improve results.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-09-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zambrana-Luque J.L., Sánchez-Benítez A., Rodríguez-Galán J., Zambrana-García J.L. ¿Cuál es el impacto de la implantación de recomendaciones «No hacer» en un bloque quirúrgico hospitalario? Rev Esp Anestesiol Reanim. 2019. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.redar.2019.11.007">https://doi.org/10.1016/j.redar.2019.11.007</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">GS: general surgery; GYN: gynaecology; OPH: ophthalmology; ORTH: orthopaedics; URO: urology.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgery in 2017 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preoperative tests in 2017 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Chest X-ray <40 years (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Surgery in 2018 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preoperative tests in 2018 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Chest X-ray <40 years (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">436 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">192 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">509 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">231 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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