Debriefing after resuscitations in a pediatric emergency department

Multiple guidelines recommend debriefing of actual resuscitations to improve clinical performance. We implemented a novel standardized debriefing program using a Debriefing In Situ Conversation after Emergent Resuscitations Now (DISCERN) tool. Following the development of the evidence-based DISCERN tool, we conducted an observational study of all resuscitations (intubation, CPR, and/or defibrillation) at a pediatric emergency department (ED) over one year. Resuscitation interventions, patient survival, and physician team leader characteristics were analyzed as predictors for debriefing. Each debriefing's participants, time duration, and content were recorded. Thematic content of debriefings was categorized by framework approach into Team Emergency Assessment Measure (TEAM) elements. There were 241 resuscitations and 63 (26%) debriefings. A higher proportion of debriefings occurred after CPR (p<0.001) or ED death (p<0.001). Debriefing participants always included an attending and nurse; the median number of staff roles present was six. Median interval (from resuscitation end to start of debriefing) & debriefing durations were 33 (IQR 15,67) and 10 minutes (IQR 5,12), respectively. Common TEAM themes included co-operation/coordination (30%), communication (22%), and situational awareness (15%). Stated reasons for not debriefing included: unnecessary (78%), time constraints (19%), or other reasons (3%). Debriefings with the DISCERN tool usually involved higher acuity resuscitations, involved most of the indicated personnel, and lasted less than 10 minutes. This qualitative tool could be adapted to other settings. Future studies are needed to evaluate for potential impacts on education, quality improvement programming, and staff emotional well-being.^

Retrospective analysis of Methicillin-Resistant Staphylococcus Aureus (MRSA) skin and Soft-Tissue Infections (SSTI) in a university hospital emergency department (ED)

Study Objective: Identify the most frequent risk factors of Community Acquired-MRSA (CA-MRSA) Skin and Soft-tissue Infections (SSTIs) using a case series of patients and characterize them by age, race/ethnicity, gender, abscess location, druguse and intravenous drug-user (IVDU), underlying medical conditions, homelessness, treatment resistance, sepsis, those whose last healthcare visit was within the last 12 months, and describe the susceptibility pattern from this central Texas population that have come into the University Medical Center Brackenridge (UMCB) Emergency Department (ED). ^ Methods: This study was a retrospective case-series medical record review involving a convenience sample of patients in 2007 from an urban public hospital's ED in Texas that had a SSTI that tested positive for MRSA. All positive MRSA cultures underwent susceptibility testing to determine antibiotic resistance. The demographic and clinical variables that were independently associated with MRSA were determined by univariate and multivariate analysis using logistic regression to calculate odds ratios (OR), 95% confidence intervals, and significance (p≤ 0.05). ^ Results: In 2007, there were 857 positive MRSA cultures. The demographics were: males 60% and females 40%, with the average age of 36.2 (std. dev. =13) the study population consisted of non-Hispanic white (42%), Hispanics (38%), and non-Hispanic black (18.8%). Possible risk factors addressed included using recreational drugs (not including IVDU) (27%) homelessness (13%), diabetes status (12.6%) or having an infectious disease, and IVDU (10%). The most frequent abscess location was the leg (26.6%), followed by the arm and torso (both 13.7%). Eighty-three percent of patients had one prominent susceptibility pattern that had a susceptibility rate for the following antibiotics: trimethoprim/sulfamethoxazole (TMP-SMX) and vancomycin had 100%, gentamicin 99%, clindamycin 96%, tetracycline 96%, and erythromycin 56%. ^ Conclusion: The ED is becoming an important area for disease transmission between the sterile hospital environment and the outside environment. As always, it is important to further research in the ED in an effort to better understand MRSA transmission and antibiotic resistance, as well as to keep surveillance for the introduction of new opportunistic pathogens into the population. ^

Ordenamento territorial em Recife-pe : Os impactos urbanísticos e sociais da realocação de comunidades através do projeto Via Mangue

The logic of territorial ordainment in Recife has been developed mainly through the seclusion of the unwanted and the removal of stilt houses and slums in order to make room and prepare the space for new private enterprises. As an example of ordainment we took the 'Via Mangue' project, which is part of Recife's mobility plan and is one of the main projects aimed at the city's preparation for the 2014 FIFA World Cup Brazil. We believe that the project makes use of the 'great social benefits' discourse in order to cover its actual and practical consequences which, taken as whole, lead to the favoring of private sector over the public interest. That being so, the main goal of the present work is to make an analysis of territorial ordainment in Recife through the execution of the Via Mangue project; observing at the same time the urban and social impacts caused by the relocation of communities to the Via Mangue III housing complex, and verifying whether this policy actually promoted substantial improvement of habitability or only a precarious social inclusion of these populations. Our research was conducted and operated at three levels. First, the conceptual reconstitution of territorial ordainment; second, documental and cartographic research on the Via Mangue project; and last, fieldwork with observation of the constructed space and personal interviews with members of the families relocated to the Via Mangue III housing complex. We hope the present work could be a valuable contribution to the comprehension of the complexities involved in the relocation of families to housing complexes built by the government

Ordenamento territorial em Recife-pe : Os impactos urbanísticos e sociais da realocação de comunidades através do projeto Via Mangue

The logic of territorial ordainment in Recife has been developed mainly through the seclusion of the unwanted and the removal of stilt houses and slums in order to make room and prepare the space for new private enterprises. As an example of ordainment we took the 'Via Mangue' project, which is part of Recife's mobility plan and is one of the main projects aimed at the city's preparation for the 2014 FIFA World Cup Brazil. We believe that the project makes use of the 'great social benefits' discourse in order to cover its actual and practical consequences which, taken as whole, lead to the favoring of private sector over the public interest. That being so, the main goal of the present work is to make an analysis of territorial ordainment in Recife through the execution of the Via Mangue project; observing at the same time the urban and social impacts caused by the relocation of communities to the Via Mangue III housing complex, and verifying whether this policy actually promoted substantial improvement of habitability or only a precarious social inclusion of these populations. Our research was conducted and operated at three levels. First, the conceptual reconstitution of territorial ordainment; second, documental and cartographic research on the Via Mangue project; and last, fieldwork with observation of the constructed space and personal interviews with members of the families relocated to the Via Mangue III housing complex. We hope the present work could be a valuable contribution to the comprehension of the complexities involved in the relocation of families to housing complexes built by the government

Ordenamento territorial em Recife-pe : Os impactos urbanísticos e sociais da realocação de comunidades através do projeto Via Mangue

The logic of territorial ordainment in Recife has been developed mainly through the seclusion of the unwanted and the removal of stilt houses and slums in order to make room and prepare the space for new private enterprises. As an example of ordainment we took the 'Via Mangue' project, which is part of Recife's mobility plan and is one of the main projects aimed at the city's preparation for the 2014 FIFA World Cup Brazil. We believe that the project makes use of the 'great social benefits' discourse in order to cover its actual and practical consequences which, taken as whole, lead to the favoring of private sector over the public interest. That being so, the main goal of the present work is to make an analysis of territorial ordainment in Recife through the execution of the Via Mangue project; observing at the same time the urban and social impacts caused by the relocation of communities to the Via Mangue III housing complex, and verifying whether this policy actually promoted substantial improvement of habitability or only a precarious social inclusion of these populations. Our research was conducted and operated at three levels. First, the conceptual reconstitution of territorial ordainment; second, documental and cartographic research on the Via Mangue project; and last, fieldwork with observation of the constructed space and personal interviews with members of the families relocated to the Via Mangue III housing complex. We hope the present work could be a valuable contribution to the comprehension of the complexities involved in the relocation of families to housing complexes built by the government