title: [Applicability of "do not do recommendations" from the National Institute for Health and Care Excellence in a quaternary care hospital].
abstract: OBJECTIVE
  To qualitatively and quantitatively identify the level of agreement between the clinical staff of a quaternary care hospital and the National Institute for Health and Care Excellence (NICE) "do not do" recommendations, and to submit a strategic alternative for effective implementation.
  
  
  METHODS
  An ad hoc form was designed to evaluate level of clinical disagreement from the experience and knowledge of the clinical staff, as well as the applicability, usefulness, effectivity and efficiency of all the NICE "do not do" recommendations that had been published up to June 2012, checking their stability up to the July 2014 update. Description of the process of design and implementation of the strategic alternative to improve compliance is presented.
  
  
  RESULTS
  The great majority (90%) of Clinical Unit directors agree with the NICE recommendations, with 64% finding them useful or very useful, 52% finding them applicable, and 32% and 34% thinking they are of high effectivity and efficiency, respectively. However, 20% of the efficient ones are not being applied. Moreover, knowledge discordances that might lead to clinical disagreements were detected. A strategic intervention, combining culture and incentives for good clinical practices, has been implemented.
  
  
  CONCLUSIONS
  The improvement in the use of the good clinical practice recommendations is directly related to the agreement of its definition and evidence. An evaluation strategy of its application by the health professionals is essential to achieve an impact in avoidable costs. Moreover, to control for harmful effects of the economic impact on patient safety, it will be necessary to simultaneously evaluate clinical/health outcome indicators tightly linked to the applied recommendations.
authors.affiliation: Servicio de Calidad y Documentación Clínica, Hospital Universitario Reina Sofía, Córdoba, España. Electronic address: santiago.martin.acera.sspa@juntadeandalucia.es.
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.affiliation: Servicio de Calidad y Documentación Clínica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: R
authors.initials: R
authors.lastname: Miñarro
authors.affiliation: Servicio de Atención Ciudadana, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: P
authors.initials: P
authors.lastname: Cano
authors.affiliation: Gerencia del Servicio Andaluz de Salud, Junta de Andalucía, Sevilla, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Aranda
mesh_terms: D001291:Attitude of Health Personnel; D019468:Disease Management; D006077:Government Agencies; D019983:Guideline Adherence; D006740:Hospital Administrators / Q000523:psychology; D006757:Hospital Units; D006801:Humans; D010564:Personnel, Hospital / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D013030:Spain; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000592:standards*
keywords: Clinical competence; Clinical practice patterns; Clinical protocols; Competencia clínica; Cost savings; Costes evitados; Evaluación resultado; Hospital units; Modelos práctica clínica; Outcomes assessment; Protocolos clínicos; Unidades hospitalarias