My name is Debbie Harnum and I have been a pediatric nurse for 26 years. Most of my career has been as a pediatric emergency department (ED) nurse at the Janeway Children’s Health and Rehabilitation Centre in St. John's, apart from a three year period on the pediatric ward at Credit Valley Hospital in Mississauga, Ontario. I am currently employed by Memorial University as the PERC Coordinator for the Janeway and part of this role includes being the TREKK coordinator for two fantastic sites - Western Memorial Hospital and Carbonear General Hospital. I have had the honour of visiting these unique facilities since March 2013.
Western Memorial Regional Hospital is nestled in the heart of the spectacularly scenic town of Corner Brook on the West Coast of Newfoundland. It is a 192 bed facility that was built in 1951, providing care and services to approximately 80,000 people from surrounding areas. The busy ED treats about 90-150 patients per day with varying levels of acuity and has a walk-in clinic within the ED which is open on evenings and weekends. They are a super friendly, proactive, highly motivated group of individuals working in aged but reasonably spacious environment.
Carbonear General Hospital stands tall in the beautiful seaside town of Carbonear on the East Coast of Newfoundland in Conception Bay North. It is a 70 bed facility that was built in the seventies and serves 40,000 people in surrounding communities. The ED staff is a very warm, hardworking and caring group who treat about 21,500 patients a year.
They have both kindly opened their doors and welcomed me in. Each visit has been a pleasure and I always walk out with a smile on my face because at the end of every day I have made genuine human connections, a pathway of communication per se. It has brought my career full circle. I now see how hard these individuals work to care for children in emergency situations with the resources they have and to deliver them to the Janeway via air or road ambulance. It was truly humbling and eye opening for me. Sometimes that piece gets lost in the larger pediatric receiving institutions.
In April my sites were chosen to take part in the qualitative portion of the Needs Assessment. Panic initially set in! How was I going to recruit for one hour focus groups in these busy EDs? How would this work? What time would be best suited and would anyone show up? Would anyone come in on their days off or would anyone stay after working a night shift?
I discovered recruitment can be challenging especially with short notice, limited time for visits, along with it being the time of year for graduations and vacations. What would work? Despite a few sleepless nights and a couple of panic emails to Lauren Albrecht (Needs Assessment Coordinator), I tried to remain upbeat and positive. In the end what worked were the human connections made on previous visits.
The Needs Assessment team flew out from Edmonton in June and we had an amazing TREKK journey across Newfoundland in such a short space of time. Our hard work paid off. We had many great conversations and took in significant amounts of information. We ended the journey with great focus groups - some large and some small. But as we discovered along the way, it is not about the numbers – it’s about the communication that takes place and the connections made.
During a camping vacation with my family in Terra Nova Park in Newfoundland, I was reminded of TREKK as I crossed over a wooden plank boardwalk to get to my morning shower. As I carefully stepped on each wooden plank, it occurred to me how essential each plank is to form a pathway over boggy ground. In many ways TREKK has been about building a boardwalk across uncertain terrain as connections, contacts, and the exchange of ideas bridge pediatric and general hospitals. TREKK is exciting – it has the potential to change pediatric emergency care across this vast and great country. Each piece of the boardwalk is equally important to keep the knowledge flowing as we get vital information on needs and preferences while building crucial relationships to assist in the dissemination of knowledge to all involved.
Huge thanks go out to the amazing pioneers, my TREKK sites Western Memorial and Carbonear General, for opening their doors and welcoming me in. Thank you to the TREKK site representatives, the Western and Eastern Research Managers for helping bring the TREKK project to fruition, the super Nurse Managers for your great interest and help with promotion of the project and finally all of the individual ED staff members for your kindness, time and patience. You have opened the information highway, laying down the first pieces of boardwalk in the East linking us with other Emergency Departments across Canada. You are all amazing individuals who are doing a great job in improving the emergency care for the children of Newfoundland and Labrador.
What a great journey and as we say here on the rock, “Yesb'y.”
From team: News and Events
TREKK has had a very eventful first year --- challenges but also some real highlights. I don’t think any of us envisaged how difficult it would be to go into each of our TREKK emergency departments (ED) with iPads to determine the knowledge needs of our health care providers and consumers. But we have persevered, and whether it was ethics or operational approval, funding agreements or other obstacles we have made great strides with over 1100 responses from providers and 350 from consumers. The prioritization committee is already starting to examine these responses for patterns and to get a sense of how best to organize the next phase of getting knowledge tools in these EDs to improve care.
Part of our success of the first year is directly tied into the quality of our team that we have been building. Having TREKK/PERC coordinators do the front end work of creating the relationship with these EDs guided by the needs assessment team in Edmonton. Our nodal leaders, PERC site leads and steering committee have provided great advice and wisdom. Our central administrative team has now been recruited and is first rate – with Lisa Knisley as knowledge broker/network manager and Christa Kruck as the research coordinator. Of course, most importantly are the TREKK sites that have generously opened their doors and allowed us to get to know them better and helped champion this important project.
We are now actively collating the refined knowledge tools that are out there – be they systematic reviews, clinical practice guidelines, pathways or preprinted order forms we will try to find them if they are of sufficient quality and relevant to the care of children in a general ED. We will look at the results of the needs survey to get a sense of how best to provide them to the TREKK sites. Do people still like paper or is the internet the way to go? Maybe everyone has a smartphone and that is the preferred method. We are open and flexible.
Telling the TREKK story, although still in its early chapters, is always very exciting for me. To have 12 PERC sites and 35 TREKK sites come together as a network in such a short time is amazing. We need to work further on strengthening and developing this network. It has been exciting to present TREKK at CAEP in Niagara Falls and CCYHC in Vancouver in 2012. On March 25, I have been invited to present TREKK at Evidence Live 2013 at Oxford University (http://www.evidencelive.org/) and they are already blogging about it (http://doc2doc.bmj.com/forums/bmj_evidence-2011_trekk-evidence-based-medicine-emergency-paediatrics).
I think what most excites me about TREKK is when I reflect on the children and their families that visit our general EDs. The possibility that we can have an impact and improve some of their outcomes is truly motivating. Together we can do so.
From team: News and Events