Today at EAST –
It’s hard to believe that today is Day #3 of the 30th Annual EAST Scientific Assembly. It’s been a fantastic conference.
My favorite part of today was the presentation of six Practice Management Guidelines (PMG’s) in the last plenary session of the conference. Prior to the presentation of the PMG’s, the EAST Guidelines Section discussed the 2012 adoption of the GRADE framework for development of PMG’s. Grading of Recommendation, Assessment, Development, Evaluation provides for a systematic, synchronized process by which outcomes are ranked, meta-analysis is conducted, literature is summarized, and recommendations are generated. The entire process is summarized in a 70 page document such that every PMG published by EAST is held to the same standard. This upcoming year, PMG’s published in years past that require updating will be carefully reviewed by the group in order to update them – facilitating current evidence-based practices are available as resources.
I appreciated the precision and care given to each recommendation mentioned in the PMG’s. If there is insufficient quality data to recommend or strongly recommend a given practice based on the GRADE framework– no matter how popular or “routine” the practice may have become in some venues – EAST is careful to abstain from making a recommendation. If there is considerable data, but the GRADE framework does not yield strong results, EAST may make a “conditional recommendation.” In this circumstance, I learned that the PMG recommendation may be appropriate for some patients, but not for others. The provider’s judgment is required to determine the best course of action for any particular patient. The overarching goal with PMG’s, is not for EAST to create “expert opinions,” but for EAST to make recommendations based on a full body of excellent data. Some of the PMG’s discussed this afternoon were around topics such as antiplatelet therapy for severe TBI patients, use of c-spine immobilization in penetrating trauma, approaches to address diaphragm injuries, and assessment of volume status & endpoints of resuscitation, among others.
One particular PMG for management of renal injuries in pediatric patients is in the early phases of GRADE. No official recommendations have been proposed, but the Guideline Section brought preliminary information forward to the assembly for conceptual feedback & suggestions. I so appreciated the section’s desire to implore the insight of others. At one point during the presentation of another unrelated PMG, I enjoyed observing a lively discussion by several EAST members who felt that the recommendations in a particular PMG were not based on a full body of research. They expressed concern that the PMG was based more on expert opinion than on the literature. As with paper presentations and poster presentations that I observed throughout other portions of the assembly, it was lovely to see the transparency with which the presenters responded to questions and challenges brought forth by the audience. My respect for the men & women of EAST is founded on the characteristics of integrity, honesty, transparency, and humility that I witnessed throughout the meeting. The culture of this “family” – as they call themselves – is one of rich and robust inquiry where one surgeon feels free to ask another how research methods may be improved or about next steps that would lead to further insight on a given topic.
A special highlight: During the awards ceremony today, I was recognized as the 2017 EAST-STN Nurse Fellow. It has been an honor and privilege to have been awarded the opportunity to attend EAST. I have loved every minute of the sessions, the people, the culture… Thank you to EAST and to STN for the collaborative that makes this opportunity possible!
Finally, in closing this blog, I want to share about the Presidential Address Dr. Stassen delivered today as the outgoing EAST president. Dr. Nicole Stassen is a very special person, and it’s been a pleasure to observe her over the past few days. She leads with ease and with gusto and she shared so beautifully this morning. Dr. Stassen’s talk, “Pay It Forward,” began with a charge to recognize the challenges faced by surgeons and by healthcare as a whole: “continued optimization of patient care, specialty equipoise, comprehensive education of trainees, resilience/burnout, quality initiatives, firearm injury…” She dove headlong into conversation about conflicting forces and the opposition we face as we fight to accomplish these goals of higher good. She spoke extensively about firearm injury and the challenges of establishing a unified, meaningful response to the weapons injury crisis of today. In so doing she acknowledged that the body of research around this issue and its confounding factors is sorely lacking… She also pointed out that without the proper information, we will not arrive at a helpful, holistic solution. Her charge seemed to be well-received, and it was evident from the rapt attention of the audience, that her leadership is greatly respected. Congratulations to you, Dr. Stassen! I don’t even know you, but I can see that you finished this year strong…and now you’ve passed on the gavel. Thank you for the way you’ve upheld EAST this year, and made this assembly something to write home about! 🙂
In closing, Cheers to you, STN! Thank you for reading this blog… I hope you gained a fun nugget to carry with you… It’s been a pleasure to share.
Just a little about your 2017 EAST-STN Fellow… Sarah Parker heralds from Atlanta, GA where she grew up. A graduate of Emory University, Sarah started her nursing career in Columbus, GA as an ED & Trauma nurse in a busy Level II adult/peds trauma center. It didn’t take long for the “trauma bug” to bite! In 2012 Sarah moved home to be closer to family and to explore the world of pediatric ED and trauma nursing at a metropolitan Level I peds trauma center. A couple of years later, eager for more trauma – and just trauma – she took a position as a Trauma Service Coordinator at Grady Memorial Hospital where she fell in love with trauma data and process improvement. Sarah’s most recent accomplishments include appointment to the ACS TQIP Project Training Team where she has the incredible opportunity to support the development of education for trauma registrars across the country. She also completed the STN Leadership Institute in December 2016, and took on a new position as Trauma Registry Manager at Grady.
Sarah and her incredible husband Lee – although they could be selling SarahLee cakes & pies – instead spend their free time with friends & family, dreaming up home improvement projects, and attempting to keep up with their vivacious, fluffy white golden doodle, Zeus.