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

ABSTRACT

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.

Acknowledgments

The authors recognize David Johnson, TREKK co-director, for his contribution to the concept and design of the knowledge pyramids. The authors also gratefully acknowledge the content advisors who created and selected resources on priority pediatric conditions for the TREKK Evidence Repository: David Johnson (croup, asthma), Amy Plint (bronchiolitis), Stephen Freedman (gastroenteritis), Graham Thompson (sepsis), Sara Reid (diabetic ketoacidosis), Kathy Boutis (fractures, lower extremity fractures, upper extremity fractures, and suspected child abuse), Roger Zemek (concussion), Lawrence Richer (status epilepticus, febrile status epilepticus), Egidio Spinelli (status epilepticus, febrile status epilepticus), Mona Jabbour (status epilepticus), Sarah Curtis (meningitis), Suzanne Beno (severe head injury, thoracoabdominal trauma, multiple trauma), Lisa Evered (procedural sedation), Maala Bhatt (procedural sedation), Karen Black (congenital heart defects), Blake Bullock (intussusception), Zebulon Timmons (intussusception), Darcy Beer (fever), Samina Ali (procedural pain, presenting pain), Amy Drendel (procedural pain, presenting pain), Carmen Coombs (suspected physical maltreatment), Amy Ornstein (suspected physical maltreatment), and Nicole Le Saux (acute otitis media). We acknowledge Serge Gouin and Marie-Christine Auclair for their assistance reviewing the French language translations of bottom line recommendations. We also recognize Jonathan Ripstein for his assistance developing the automated program that translates bibliographic records from Excel to the trekk.ca web platform, and the work of Rebecca Buttar and Kassi Shave at ARCHE who translated Excel metadata files for uploading to trekk.ca. Finally, the authors acknowledge Leah Crockett for providing administrative support as a Knowledge Broker for TREKK and CHRIM.

Funding

This work was supported through the Government of Canada’s Networks of Centres of Excellence Knowledge Mobilization Initiative and the Women and Children's Health Research Institute. Dr. Lisa Hartling is supported by a New Investigator Salary Award from the Canadian Institutes of Health Research. Dr. Shannon Scott is supported by a Canada Research Chair (Tier 2) and a Population Health Investigator Award from Alberta Innovates Health Solutions.

Supplementary Material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported through the Government of Canada’s Networks of Centres of Excellence Knowledge Mobilization Initiative. Dr. Lisa Hartling is supported by a New Investigator Salary Award from the Canadian Institutes of Health Research. Dr. Shannon Scott is supported by a Canada Research Chair (Tier 2) and a Population Health Investigator Award from Alberta Innovates Health Solutions.