Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment

Developing a Tool for Assessing the Process of Seeking Health Information: Online Think-Aloud Method

Nursing students can access massive amounts of online health data to drive cutting-edge evidence-based practice in clinical placement, to bridge the theory-practice gap. This activity requires investigation to identify the strategies nursing students apply to evaluate online health information. Online Think-Aloud sessions enabled 14 participants to express their cognitive processes in navigating various educational resources, including online journals and databases, and determining the reliability of sources, indicating their strategies for information-seeking, which helped to create this scoring system. Easy access and user convenience were clearly the instrumental factors in this behavior, which has troubling implications for the lack of use of higher-quality resources (e.g., from peer-reviewed academic journals). The identified challenges encountered during resource access included limited skills in the critical evaluation of information credibility and reliability, signaling a requirement for improved information literacy skills. Participants acknowledged the importance of evidence-based, high-quality information, but faced numerous barriers, such as restricted access to professional and specialty databases, and a lack of academic skills training. This paper develops and critiques a Performative Tool for assessing the process of seeking health information using an online Think-Aloud method, and explores factors and strategies contributing to evidence-based health information access and utilization in clinical practice, aiming to provide insight into individuals' information-seeking behaviors in online health contexts.

Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods

AIM

The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system.

DESIGN

Quasi-experimental mixed methods using co-production.

METHODS

Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays.

RESULTS

Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning.

PATIENT OR PUBLIC CONTRIBUTION

Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.

Bridging evidence-to-care gaps with mHealth: Designing a symptom checker for parents accessing knowledge translation resources on acute children's illnesses in a smartphone application

Background

Smartphone applications offer a novel platform for delivering health information to parents. This study created and evaluated an app-based symptom checker that recommends educational tools to parents based on their child's symptoms.

Methods

Symptoms extracted from 23 knowledge translation (KT) tools for 10 children's illnesses comprised a set of plain-language symptoms. The symptom checker works by producing confusion matrices evaluating a child's reported symptoms against possible illnesses, comparing precision scores to examine how well each illness matched reported symptoms, and ordering possible illnesses by performance score. Performance was evaluated by extracting symptoms from 8 clinical vignettes, and examining correct first-try matches.

Results

We created a final list of 54 plain-language symptoms. Visualizations of the symptom set creation process and logic mapping are presented, as well as images of the working symptom checker. The symptom checker matched 100% (8/8) of tested clinical vignettes to the appropriate illness resource.

Discussion

Symptom checkers are a potentially useful tool to integrate into apps that parents use for their children's health. The design of these systems has the potential to change parents' relationship with technology, affecting both their adoption and acceptance of symptom checkers. Our design choices contribute to addressing current barriers to the adoption of symptom checkers, reducing functional, critical, and interactive literacy requirements for parents.

A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery

Background

With increasing prevalence of severe obesity in youth, more adolescents are becoming candidates for bariatric surgery. In Canada, bariatric surgery in adolescents is in its infancy, and long-term health outcomes are not well known. It is unknown what health care providers (HCPs) are using to prepare and guide their adolescent patients for bariatric surgery. The needs of HCPs should be explored with the aim to improve patient outcomes. Therefore, the purpose of this study was to investigate the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery.

Methods

This qualitative study consisted of a focus group with seven HCPs from an adolescent bariatric program using a semi-structured interview guide. The focus group discussion was audio-recorded, and the recording was transcribed verbatim. A thematic analysis was conducted.

Results

Four data-generated themes emerged highlighting the perceived needs and challenges faced by HCPs. These included (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets.

Conclusion

This needs assessment study highlights the need for appropriate resources for patient education, as well as pre and post-operative preparation. The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients.

Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases

BACKGROUND

Radiograph use contributes to low-value care for children in emergency departments (EDs), but little is known about systemic factors associated with their use. This study compares low-value radiograph use across ED settings by hospital type, pediatric volumes and physician specialty.

METHODS

This is a cross-sectional study of routinely collected administrative data. We included children (age 0-18 yr) discharged from EDs in Ontario, Canada, between 2010 and 2019 with diagnoses of bronchiolitis, asthma, abdominal pain and constipation. Multiple clinical practice guidelines recommend against routine radiograph use in these conditions. Logistic regression evaluated odds of low-value radiograph by ED setting (pediatric academic [referent], adult academic, community with or without pediatric consultation services), pediatric volume and physician specialty (pediatric emergency medicine [PEM, referent], emergency medicine [EM], family medicine with EM training, pediatrics, family medicine), adjusting for demographic, clinical and provider characteristics. We used generalized estimating equations to account for clustering by ED.

RESULTS

Of the total 9 862 787 eligible pediatric ED discharges in Ontario, 60 914 children had bronchiolitis, 141 921 asthma, 333 332 abdominal pain and 110 514 constipation; 26.0% received low-value radiographs. Compared with pediatric EDs and PEM physicians (referents), patients with bronchiolitis were most likely to have a chest radiograph in adult academic EDs (adjusted odds ratio [OR] 5.1 [95% confidence interval (CI) 4.6-5.6]) and by family physicians with EM training (adjusted OR 4.8 [95% CI 4.5-5.1]). Patients with asthma were more likely to have a chest radiograph in adult academic EDs (adjusted OR 3.0 [95% CI 2.8-3.2]) and by EM physicians (adjusted OR 2.8 [95% CI 2.6-3.0]). Patients with abdominal pain and constipation were more likely to have abdominal radiographs in community hospitals with pediatric consultation (adjusted OR 1.6 [95% CI 1.6-1.7] and 2.3 [95% CI 2.3-2.4], respectively) and by family physicians with EM training (adjusted OR 1.6 [95% CI 1.6-1.7] and 2.1 [95% CI 2.0-2.2], respectively).

INTERPRETATION

Over the decade-long study period, low-value radiograph use was frequent for children with 4 common conditions seen in Ontario EDs. Quality improvement initiatives aimed at reducing unnecessary radiographs in children should focus on EM physicians practising in EDs that primarily treat adult patients.

The feasibility of a pediatric distance learning curriculum for emergency department nurses during the COVID-19 pandemic: An Improving Pediatric Acute Care Through Simulation (ImPACTS) collaboration

Introduction

To develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative.

Methods

Kern’s 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists.

Results

Thirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P = .018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P = .016). Feedback included a shortened intervention and including physician participants.

Discussion

A longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses’ knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope.

Egyptian physicians' information-seeking behavior while serving in public isolation hospitals for coronavirus patients

Purpose

The purpose of this study is to explore the information-seeking behavior of Egyptian physicians serving in COVID-19 isolation hospitals.

Design/methodology/approach

A sample of 91 physicians serving in Egyptian isolation hospitals answered the study questionnaire.

Findings

Demographically, more than half of respondents were males. Over one-third of them are holding Doctor of Medicine (M.D), followed by one-third holding Master of Medicine (MMed). Respondents' age ranged from 30 to 60 years. Internal medicine is the most common specialty, accounting for nearly half of all physicians, followed by chest medicine and intensive care medicine. The information-seeking behavior of these three groups in their regular work is believed to be different, but since all of the participants are working in COVID-19 isolation hospitals, they should have the same information resources, Internet access and the same needs relevant to COVID-19 in order to make accurate clinical decisions. The physicians used traditional and electronic information sources to fulfill their information needs, the most important of which were to make a specific research, find an answer to a specific case, and deliver a medical lecture. Colleagues, coworkers, nurses and pharmacists were the most important channels pursued by Egyptian physicians to obtain information.

Originality/value

This study is the first study that focuses on investigating the information-seeking behavior of Egyptian physicians serving in isolation hospitals. Any findings resulted from this study may serve as a noteworthy reference that may be useful to the Egyptian health sector, experts, researchers, as well as policymakers in establishing strategic decisions for making the understating much better.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0350

Going viral: A scoping review of the current state and impact of online research dissemination in emergency medicine

BACKGROUND

The use of free open-access medical education (FOAM) and other online knowledge dissemination methods has increased over the past decade. However, the role and impact of these tools in the knowledge translation continuum are poorly understood, potentially limiting the ability of knowledge generators to fully harness and exploit their potential. Here, we aim to comprehensively map and synthesize the literature describing the use of online tools for the dissemination of emergency medicine research.

METHODS

Using scoping review methodology, we searched the traditional literature via PubMed, CINAHL, EMBASE, ERIC, SCOPUS, and the gray literature for publications exploring online methods to disseminate new research findings. We synthesized the results and constructed a conceptual model of current research dissemination methods.

RESULTS

We included 79 out of 655 unique abstracts and articles identified in our search, 62 of which were from the traditional literature. We describe six primary domains: integration with traditional literature, measurement of dissemination, online organizations and communities of practice, professional development, quality assurance tools and techniques, and advantages and disadvantages of FOAM. For each domain we present an exemplar article and prevailing gaps in knowledge. Finally, we propose a current conceptual framework for dissemination of new research findings that describes both traditional and novel methods of dissemination.

CONCLUSIONS

This comprehensive review of the literature and current dissemination framework will empower researchers, research networks, and granting organizations to maximize their use of FOAM and other online methods to disseminate new knowledge as well as provide clinicians a better understanding of the tools and methods by which to access and implement new research findings.

Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan

Background

Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. 

Objective

The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved.

Methods

We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores.

Results

Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy.

Conclusions

There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design.

Development and evaluation of a parent advisory group to inform a research program for knowledge translation in child health

BACKGROUND

In response to a growing movement to involve patients and community stakeholders in health research, we established a parent advisory group in 2016. The group meets regularly to act as advisors and partners for our research program. The purpose of this paper is to describe our experiences establishing the group, and results from parent evaluations.

METHODS

We contacted 191 organizations to recruit parents and caregivers of children who wanted to contribute to child health research. Our initial goal was to recruit 8 to 10 parents who would meet regularly (approximately 8 times per year). We conducted an online baseline survey of members after the first two meetings to understand motivations for participating and early experiences. Sixteen months later we conducted another online survey to identify what was going well and areas for improvement.

RESULTS

Twelve parents initially joined the group. The baseline survey (n = 9 complete) identified motivations for participation: wanting a patient/family voice in health research; personal experience accessing health system for child's care; wanting to improve healthcare communications. Concerns about participation included: having sufficient time to attend meetings; whether contributions would be worthwhile; and uncertainty about how the group's input would be used in practice. Parents identified aspects that were working well: opportunity to provide constructive feedback; diversity among parents involved; well-run and organized meetings (agenda and materials sent prior to meeting, skilled facilitation, adequate time for discussion). Items parents identified as not working well were: fluctuating attendance; not knowing others in the group; challenges if attending remotely. At follow-up, there were seven active members. The follow-up survey (n = 5 complete) identified positive feedback related to group dynamics (e.g., collegial, everyone participates) and organization of meetings. Suggestions for improvement included increasing membership, regular attendance, and providing adequate information/context to allow meaningful input.

CONCLUSIONS

Our experience establishing a parent advisory group and evaluation of the group by parent members have yielded tremendous insights around involving parents and patient proxies in health research. The parent advisory group is a dynamic entity requiring ongoing communication between researchers and members. Effective means of evaluating engagement is essential to ensure it is meaningful. Dedicated time, funding and resources are required for success.

Cultural Adaptation of Digital Knowledge Translation Tools for Acute Otitis Media in Low- to Middle-Income Countries: Mixed Methods Usability Study

BACKGROUND

Acute otitis media (AOM) is the most common pediatric bacterial ear infection. AOM presents challenges to parents who lack accurate information. Digital knowledge translation tools offer a promising approach to communicating complex health information. We developed AOM knowledge translation tools for Canadian parents and augmented them for Pakistani parent end users.

OBJECTIVE

This pilot study aimed to (1) develop AOM knowledge translation tools for Canadian parents, (2) adapt the knowledge translation tools across cultural contexts, and (3) evaluate the usability of the adapted knowledge translation tools.

METHODS

Parents' perceptions of the translated knowledge translation tools' usability were explored using a mixed-methods design. We recruited parent participants from a hospital in Pakistan to complete usability surveys (n=47) and focus group interviews (n=21). Descriptive statistics and content analysis were used to analyze data.

RESULTS

Usability results showed the usefulness and effectiveness of both adapted knowledge translation tools. Parents reported preferring a digital media narrative format in their own language. Findings revealed that culturally adapted knowledge translation tools are effective in transferring health information to parents.

CONCLUSIONS

Digital knowledge translation tools offer a promising approach to improving health literacy and communicating complex health information to parents of children with AOM. Culturally adapting the tools generated important knowledge that will contribute to knowledge translation advancements. Evaluation of the tool effectiveness is a critical next step to exploring the impact of knowledge translation tools on child health outcomes.

Development of a whiteboard video for managing trauma patients outside a tertiary trauma centre

This article describes the process of developing an educational whiteboard video for community trauma management and transport. Whiteboard videos have become widely used as educational resources for various medical subject matters. These short videos package information concisely through real-time illustration with an accompanying narration. Based on a needs assessment we created a free open access educational resource for community trauma management and transport. A group of interdisciplinary trauma providers partnered in content/script development, video design and dissemination. A third-party production company oversaw video animation and voice-over. The video was disseminated widely through stakeholders and various multimedia channels. We surveyed a sample of our intended audience and the majority of respondents perceived the video to be an effective educational resource. Although cost may represent a potential barrier for producing whiteboard videos, there appears to be a role in creating educational content using this multimedia format.

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

BACKGROUND

Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice.

METHODS

This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one-on-one, semistructured interviews. Audio recordings were transcribed and coded by a multi-investigator team drawing on theory produced from comparative analysis.

RESULTS

We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes.

CONCLUSIONS

General ED providers struggled with critically ill children because they could not anticipate their pediatric-specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider-focused interventions to address gaps in pediatric-specific continuing medical education, just-in-time assistance, and knowledge transfer.

Knowledge Translation Strategies Used by Healthcare Professionals in Child Health Settings: An Updated Systematic Review

PROBLEM

Strategies assisting healthcare professionals to make evidence-based decisions are crucial for quality patient care and outcomes. To date, there is one systematic review (Albrecht et al., 2016) examining knowledge translation (KT) efforts in child health settings. This systematic review aims to provide an update on current evidence identifying KT interventions implementing research into child health settings.

ELIGIBILITY CRITERIA

Nine electronic databases were searched, restricted by date (2011-2018) and language (English). Eligibility included: 1) randomized controlled trials (RCT), controlled clinical trials (CCT), or controlled before-and-after (CBA) studies; 2) interventions implementing research into child health practice; and 3) outcomes were measured at the healthcare professional/process, patient, or economic level.

SAMPLE

Health care professionals working in child health settings.

RESULTS

48 studies (38 RCT, 7 CBA, 3 CCT) were included. Studies employed single (n = 34) and multiple (n = 14) interventions. The methodological quality of studies was moderate (n = 18), strong (n = 16) and weak (n = 14). Studies showing significant, positive effects included (n = 9) RCTs, (n = 3) CBAs and (n = 2) CCTs. These studies employed (n = 11) single KT interventions and (n = 3) multiple KT interventions. Interventions included educational (n = 6), reminders (n = 3), computerized decision supports (n = 2), multidisciplinary teams (n = 2) and financial and educational interventions combined (n = 1).

CONCLUSIONS

Effective KT strategies used by health care professionals in child health settings were found to be online education curriculums and computerized decision supports or reminders.

IMPLICATIONS

This review update serves as an up-to-date 'state of the science' on KT strategies used in pediatric health professionals' clinical practice, assessed by the most rigorous research designs.

Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps

Emergency care providers share a compelling interest in developing an effective patient-centered, outcomes-based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC)" aimed to fulfill this role. This conference convened major thought leaders and stakeholders to introduce a research, scholarship, and innovation agenda for pediatric emergency care specifically to reduce health outcome gaps. Planning committee and conference participants included emergency physicians, pediatric emergency physicians, pediatricians, and researchers with expertise in research dissemination and translation, as well as comparative effectiveness, in collaboration with patients, patient and family advocates from national advocacy organizations, and trainees. Topics that were explored and deliberated through subcommittee breakout sessions led by content experts included 1) pediatric emergency medical services research, 2) pediatric emergency medicine (PEM) research network collaboration, 3) PEM education for emergency medicine providers, 4) workforce development for PEM, and 5) enhancing collaboration across emergency departments (PEM practice in non-children's hospitals). The work product of this conference is a research agenda that aims to identify areas of future research, innovation, and scholarship in PEM.

A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments

In 2018, the Society for Academic Emergency Medicine and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session, "Emergency Department Collaboration-Pediatric Emergency Medicine in Non-Children's Hospital"). This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement (QI) experts, as well as a patient advocate, identified main outcome gaps in the care of children in the emergency departments (EDs) in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation. The goal for this session was to create a research agenda that facilitates collaboration and partnering of diverse stakeholders to develop a system of care across all ED settings with the aim of improving quality and increasing safe medical care for children. The following recommended research strategies emerged: explore the use of technology as well as collaborative networks for education, research, and advocacy to develop and implement patient care guidelines, pediatric knowledge generation and dissemination, and pediatric QI and prepare all EDs to care for the acutely ill and injured pediatric patients. In conclusion, collaboration between general EDs and academic pediatric centers on research, dissemination, and implementation of evidence into clinical practice is a solution to improving the quality of pediatric care across the continuum.

Creation of an Integrated Knowledge Translation Process to Improve Pediatric Emergency Care in Canada

TREKK (Translating Emergency Knowledge for Kids) was established to address knowledge needs to support care of children in general emergency departments. To achieve this goal, we developed an integrated knowledge translation (KT) process based on identified priorities to create the TREKK Evidence Repository, containing "knowledge pyramids" and Bottom Line Recommendations (summary documents) on the diagnosis and treatment of emergency pediatric conditions. The objective of this article is to describe our methods for developing and disseminating the TREKK Evidence Repository to improve pediatric emergency care in Canada. Our work was guided by the research question: Can an integrated KT process address an information gap in healthcare practice? We utilized a pyramid-shaped framework, built upon the "4S" hierarchy of evidence model, to provide detailed evidence appropriate to stakeholders' needs. For each priority condition (asthma, bronchiolitis, croup, etc.), clinical advisors and KT experts collaborated to create a Bottom Line Recommendation and to select guidelines, reviews, and key studies for that condition's topic area in the Evidence Repository on the TREKK website (trekk.ca). Targeted promotion, including a social media campaign, communicated the availability of new topics in the Evidence Repository and available knowledge tools. Feedback from 35 end-users on pilot versions of the Evidence Repository was positive with 91% indicating that they would use the resource in the emergency department. Using an integrated KT process, we responded to end-users' requests for varying level of information on priority pediatric conditions through the creation of knowledge tools and development of a process to identify and vet high quality evidence-based resources.

Dissemination of evidence in paediatric emergency medicine: a quantitative descriptive evaluation of a 16-week social media promotion

OBJECTIVES

TRanslating Emergency Knowledge for Kids (TREKK) and Cochrane Child Health collaborate to develop knowledge products on paediatric emergency medicine topics. Via a targeted social media promotion, we aimed to increase user interaction with the TREKK and Cochrane Child Health Twitter accounts and the uptake of TREKK Bottom Line Recommendations (BLRs) and Cochrane systematic reviews (SRs).

DESIGN

Quantitative descriptive evaluation.

SETTING

We undertook this study and collected data via the internet.

PARTICIPANTS

Our target users included online healthcare providers and health consumers.

INTERVENTION

For 16 weeks, we used Twitter accounts (@TREKKca and @Cochrane_Child) and the Cochrane Child Health blog to promote 6 TREKK BLRs and 16 related Cochrane SRs. We published 1 blog post and 98 image-based tweets per week.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was user interaction with @TREKKca and @Cochrane_Child. Secondary outcomes were visits to TREKK's website and the Cochrane Child Health blog, clicks to and views of the TREKK BLRs, and Altmetric scores and downloads of Cochrane SRs.

RESULTS

Followers to @TREKKca and @Cochrane_Child increased by 24% and 15%, respectively. Monthly users of TREKK's website increased by 29%. Clicks to the TREKK BLRs increased by 22%. The BLRs accrued 59% more views compared with the baseline period. The 16 blog posts accrued 28% more views compared with the 8 previous months when no new posts were published. The Altmetric scores for the Cochrane SRs increased by ≥10 points each. The mean number of full text downloads for the promotion period was higher for nine and lower for seven SRs compared with the 16-week average for the previous year (mean difference (SD), +4.0 (22.0%)).

CONCLUSIONS

There was increased traffic to TREKK knowledge products and Cochrane SRs during the social media promotion. Quantitative evidence supports blogging and tweeting as dissemination strategies for evidence-based knowledge products.

Knowledge sharing between general and pediatric emergency departments: connections, barriers, and opportunities

OBJECTIVE

Translating Emergency Knowledge for Kids (TREKK) is a national network aimed at improving emergency care for children by increasing collaborations and knowledge sharing between general and pediatric emergency departments (EDs). This study aimed to determine patterns of knowledge sharing within the network and to identify connections, barriers, and opportunities to obtaining pediatric information and training.

METHODS

We conducted 22 semi-structured interviews with health care professionals working in general EDs, purposefully sampled to represent connected and disconnected sites, based on two previous internal quantitative social network analyses (SNA). Data were analyzed by two independent reviewers.

RESULTS

Participants included physicians (59%) and nurses (41%) from 18 general EDs in urban (68%) and rural/remote (32%) Canada. Health care professionals sought information both formally and informally, by using guidelines, talking to colleagues, and attending pediatric related training sessions. Network structure and processes were found to increase connections, support practice change, and promote standards of care. Participants identified personal, organizational and system level barriers to information and skill acquisition, including resources and personal costs, geography, dissemination, and time. Providing easy access to information at the point of care was promoted through enhancing content visibility and by embedding resources into local systems. There remains a need to share successful methods of local dissemination and implementation across the network, and to leverage local professional champions such as clinical nurse liaisons.

CONCLUSIONS

These findings reinforce the critical role of ongoing network evaluation to improve the design and delivery of knowledge mobilization initiatives.