CHOOSING WISELY: FIVE TOPICS REFLECTING APPROPRIATE CARE        

JOINT SESSION WITH ESA

What is deemed appropriate in terms of care has been a hot button topic in recent times and this session chaired by Sharon Einav (Jerusalem, Israel) and Greet Van den Berghe (Leuven, Belgium) really seeks to zone in on the central themes at play.

In 2012 the American Board of Internal Medicine launched the national “Choosing Wisely” campaign with the intention of providing medical practitioners and patients a list of evidence-based recommendations regarding medical tests, treatment and procedures. This initiative stemmed from a survey demonstrating that most doctors believe there is significant redundancy in current medical practice. More than 70  medical societies have provided recommendations relevant to their specialties. Each of the 5 speakers on the panel will discuss a recommendation of the Society of Critical Care Medicine.

Sharon Einav will open up this comprehensive session with her griping presentation entitled “To test or not to test”, which will focus on avoidance of routine testing. The talk will include a discussion of positive predictive value, deterministic and probabilistic interpretation of “abnormal” results and the figurative and non-figurative cost of testing. 

“Knowledge is merely brilliance in organisation of ideas and not wisdom. The truly wise person goes beyond knowledge.” (Confucius) 

Blood transfusion practices are the focus of Daniela Filipescu's presentation (Bucharest, Romania). 

The high variability of in hospital transfusion rates for all blood product types persists all over the world. New data from the European Transfusion Practice and Outcome Study (ETPOS) reveal some old habits:

41% percent of patients received 2 units of blood intraoperatively, approximately 50% of patients were over-transfused despite largely declared adherence to restrictive transfusion policies and use of physiological transfusion triggers, most of the physiological transfusion triggers were hypotension and tachycardia, haemoglobin value was still an open or hidden transfusion trigger, only 1% of patients were optimized with iron and/or erythropoietin prior to surgery despite 82% being anaemic preoperatively, and fresh frozen plasma is still the most used agent during intraoperative bleeding. (Meier J, et al. Intraoperative transfusion practices in Europe. Br J Anaesth. 2016 Feb;116:255-61)

In this context, it is time to change the focus from liberal-restrictive transfusion practice discussion to some call for action: let’s treat anemia preoperatively, one unit policy campaign, and speak out Patient Blood Management! 

Claudia Spies (Berlin, Germany) will answer the question "Sedation vacations or unplanned extubations?" in her presentation.

Sedation, pain and delirium management are paramount elements of intensive care. Recently, guidelines have been published that emphasize the use of evidence-based protocols. The European concept “Comfort and patient-centred care without excessive sedation: the eCASH” gives recommendations to achieve “Comfort using Analgesia, minimal Sedatives and maximal Humane care” and reflects the European perspective. It may finally be time to say goodbye to daily sedation interruptions and aim for an awake patient.

Also in this session: Greet Van den Berghe will focus on "TPN timing and temerity".

In his talk, Jozef Kesecioglu (Utrecht, Netherlands) tackles the quandray "Early advanced care planning: An alternative to end-of-life care?"

"Academic assumptions concerning early advanced care are different than patients’ perceptions”.

Advance care planning should prepare patients and surrogates to work with their clinicians to make the best possible in-the-moment medical decisions rather than aiming advance treatment decisions. Clinicians can help prepare patients and surrogates in the outpatient setting to communicate their values and needs when the time comes to make a decision and to establish leeway in surrogate decision making.

This is a must-see session… Mark it on your congress agenda!

Joint Session with ESA ~ CHOOSING WISELY: FIVE TOPICS REFLECTING APPROPRIATE CARE

03.10.2016, 14:15 – 15:45, room Barcelona

#LIVES2016 #ethic