Quecedo Gutiérrez L, Ruiz Abascal R, Calvo Vecino J M, Peral García A I, Matute González E, Muñoz Alameda L E, Guasch Arévalo E, Gilsanz Rodríguez F
Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital La Princesa, Madrid, España.
Sección de Gestión Clínica de la SEDAR, Servicio de Anestesia, Hospital Sanitas La Moraleja, Madrid, España.
Rev Esp Anestesiol Reanim. 2016 Nov;63(9):519-527. doi: 10.1016/j.redar.2016.05.002. Epub 2016 Jul 12.
In April 2013 the Ministry of Health (MSSSI) adopted the project called "Commitment to Quality by Scientific Societies in Spain", in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree "do not do" recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 "do not do" recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss.
2013年4月，卫生部（MSSSI）采纳了名为“西班牙科学学会对质量的承诺”的项目，以回应社会和专业人士对卫生系统可持续性的要求。该倡议是国家卫生系统卫生技术评估和服务西班牙机构网络活动的一部分，由质量与凝聚力部门、阿拉贡健康科学研究所（IACS）和西班牙内科医学会（SEMI）联合协调。西班牙所有科学学会都被纳入了该项目，其主要目标是减少卫生干预措施的不必要使用，以便根据科学证据达成“不做”建议。主要目标是确定那些尚未证明有效的干预措施、有效性有限或存疑的干预措施、不具有成本效益的干预措施或不具有优先性的干预措施。次要目标包括：减少临床实践中的变异性，在医生和患者之间传播信息以指导决策，合理使用卫生资源，以及促进临床安全并减少医源性疾病。5项“不做”建议的选择过程采用德尔菲法。共有25名小组成员（均为麻醉医生）根据以下因素从15项提议中进行选择：支持质量、相关性或临床影响的证据，以及受其影响的人群。提议的5项建议是：在无特定指征的情况下，不要对危重症患者维持深度镇静；对于ASA身体状况为I或II级的40岁以下患者，不要进行术前胸部X光检查；除非根据临床病史和体格检查另有指示，否则不要在白内障手术中系统性地进行术前检查；在对有出血风险的贫血患者进行诊断性检查并给予治疗之前，不要进行择期手术；对于预计失血极少的健康或低风险患者（ASA I和II级），不要在手术前进行实验室检查（血细胞计数、生化和凝血检查）。
