Knowledge and level of implementation of "Do Not Do" recommendations in Spanish pediatric surgery departments.

Abstract

Objectives: In recent decades, initiatives have been developed to promote the de-implementation of low-value practices through "do not do" recommendations (RNH). This study aimed to estimate the level of awareness and the state of implementation of representative RNH in Pediatric Surgery Departments within the Spanish National Health System (SNS), as the initial phase of the NOCIPE project, endorsed by the Spanish Society of Pediatric Surgery (SECP).

Material and methods: Observational, descriptive, cross-sectional study using a self-administered survey addressed to the heads of Pediatric Surgery departments within the SNS. Descriptive analysis and non-parametric comparisons for independent samples were performed.

Results: A total of 16/37 (43%) responses were obtained. Among respondent centers, 9 (56.2%) reported having a clinical practice appropriateness entity, and 5 (31.2%) included RNH in management agreements. The median number of RNH assessed per center was 6.5/8 known (81%; IQR 3), 5/8 implemented (62%; IQR 4), and 1/8 measured (12%; IQR 1). No significant differences were observed in the number of implemented RNH according to the presence of an appropriateness entity or inclusion in management agreements. Nine additional RNH were collected and used as a complementary source in subsequent phases of the project.

Conclusions: The findings reveal a significant gap between awareness, implementation, and particularly the measurement of RNH, highlighting the need to strengthen dissemination strategies, facilitate implementation, and standardize indicators and tools to assess their impact and guide comparable improvements across centers.