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

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.E ach year in the United States, approximately 35 million children are evaluated in an emergency department (ED). Secondary to hospital distribution and geographic limitations, 1 the large majority (95%) of these children are seen in a general emergency department (GED), 2 as opposed to a dedicated

Section: Discussionmentioning

confidence: 99%

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

Query

Olson

Meyer

et al. 2018

“…A multitude of ongoing initiatives (Data Supplement , available as supporting information in the online version of this paper, which is available at http://onlinelibrary.wiley.com/doi/10.1111/acem.13642/full) is making progress through the development of resources, measurement tools, standards, and requirements. In addition, collaboration has been evident in some pediatric‐specific hospitals creating programs over the past decade involving innovative models in the ED (e.g., partnership in staffing general EDs and sharing policies/procedures, health system–based networks of pediatric emergency care), educational outreach, telemedicine, and use of simulation …”

Section: Conceptual Framework and Creation Of The Research Agendamentioning

confidence: 99%

“…For example, a Canadian network, TRanslating Emergency Knowledge for Kids (TREKK), has completed a series of projects to improve emergency care across all EDs by developing pediatric resources available to all settings. The group has identified the preferred topics and methods of delivery for content by general ED providers and have created online resources in collaboration with these frontline providers …”

Section: Conceptual Framework and Creation Of The Research Agendamentioning

confidence: 99%

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

Barata

Auerbach

Badaki-Makun

et al. 2018

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.

“…After this lunchtime panel session, all conference participants then attended either the workforce development for PEM breakout session or the enhancing collaboration across EDs (PEM practice in non–children's hospitals) breakout session, working in the same fashion as the morning sessions. Terry Klassen, MD, MSc, then gave the closing address, describing opportunities in translational research to decrease the gaps between evidence‐based knowledge and clinical practice . The consensus ideas, challenges, and conclusions from all of the five breakout sessions were then summarized and presented by the subcommittee chairs, followed by adjournment after concluding remarks by the consensus conference chairs.…”

Section: Conference Agenda (Figure )mentioning

confidence: 99%

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

Ishimine

Adelgais

Barata

et al. 2018

Emergency care providers share a compelling interest in developing an effective patient-centered, outcomesbased 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.