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A qualitative ‘TREKK’ across Newfoundland

October 29, 2013

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

tags: Research    


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A Bird in the Hand is Better than Two in the Bush: Observations about Data Collection

July 22, 2013

As the TREKK Needs Assessment Coordinator since October 2011, I have gained a considerable amount of experience teaching people HOW to collect survey data and HOW to recruit survey participants, but until recently, I had no experience DOING the recruitment in the TREKK sites. In June 2013, I had the pleasure of conducting my first site visits to Western Memorial Hospital in Corner Brook, Newfoundland and Carbonear General Hospital in Carbonear, Newfoundland. The purpose of this trip was to complete survey data collection and begin small-scale qualitative data collection. It was a highly successful trip and I learned a lot - including how difficult recruitment is. Luckily, we had a guide.

Debbie Harnum, the Newfoundland TREKK Coordinator, was our key contact in both sites. When we arrived, it was immediately obvious that she had spent a significant amount of time building relationships with the staff and the managers in both hospitals. Her bubbly personality, her passion for people, her pediatric nursing background, and her interest in research ignited and fostered relationships that resulted in excellent survey response rates. These relationships also allowed us, virtual strangers from Edmonton, to successfully conduct focus groups and observations over short four day visits to each site. 

Throughout this process, I was struck by the feeling that it was never enough – that there were always more people to meet, to talk to about TREKK, and to include in our mission of mobilizing knowledge. While this urge to be inclusive and to maximize our participants lead us to meet some wonderful individuals and to have some fantastic conversations, it also gave us feelings of disappointment when individuals weren’t interested in the Needs Assessment or in research, period. As a team, we had great discussions about balancing resources to achieve our recruitment goals while at the same time staying within our ethical and financial boundaries. We debated how to reduce and even eliminate barriers to participation, while at the same time respecting individuals’ right to refuse to participate and even withdraw if they so chose. We were also able to talk personally about how we, as part of the Needs Assessment team, can get caught up in our passion for the project and our desire to achieve our targets – and we can forget to be thankful for the people we have met, the rich data we have collected, and ultimately the experiences we’ve gained, in pursuit of getting one more survey completed or one more participant for the focus group. It’s a fine line to walk.

But the beauty of building relationships, rather than focusing on numbers, is that the connection to these sites will last beyond the survey, beyond the focus group, and beyond the Needs Assessment phase. This is the true mission of our work – to create sustainable, long-term relationships that will facilitate knowledge mobilization and ultimately result in better outcomes for kids. And it is thanks to the hard work of all the TREKK Coordinators and Research Assistants over the course of the Needs Assessment phase that this mission is possible.

TREKK Team rescues lost pet cockatiel in Bay Roberts, Newfoundland

When we weren’t busy at the hospital collecting data, we were rescuing lost birds! We found ‘Peaches’ on the side of the road one day (surrounded by crows), so we took her in and made her a home while we tracked down her owner. We successfully returned the bird to her family on the last day of our visit to Bay Roberts. Who says research is boring?!?!

 Click on the pictures below to see how we met our friend Peaches.

From team: News and Events

Documents

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[file] Peaches_2.jpg 210 kb Picture

[file] Debbie_and_Peaches.jpg 207 kb Picture


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A summer project to find online resources

June 24, 2013

Hello, my name is Alexandra Dionisopoulos. I’m working on a summer project with Dr Eddy Lang in Calgary to identify online resources for the emergency care of children. I recently graduated with a Bachelor of Science in Psychology from McGill University and will be starting medical school in the fall, hoping to pursue a career in pediatrics.

The overall objective of the project is to develop and evaluate an online library of high quality, evidence-based resources that can support health care providers caring for children in community emergency departments. The TREKK Needs Assessment is identifying the knowledge needs of health care providers working in general emergency departments across Canada. This Needs Assessment, along with the work from the prioritization committee, is guiding which online resources to search for. 

The evaluation will consist of a screening process, drawn from the Health On the Net quality assessment tool.  I will then be gathering feedback from clinicians in the TREKK network on how useful the resources are.

 I look forward to working with the TREKK team. If you have any comments or questions about the project, feel free to get in touch at trekk@mich.ca 

For more information about TREKK visit http://trekk.ca/about

From team: News and Events


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View from the north - David Pontin

May 11, 2013

David Pontin, TREKK site lead at Stanton Territorial Hospital in the Northwest Territories

Hello from North of 60!

My name is Dr. David Pontin; I am an emergency physician working in Yellowknife and an enthusiastic supporter of the TREKK initiative. 

In the NWT, we have a small population spread across an enormous geographic area, a basic fact that makes providing timely and effective healthcare to our patients extremely challenging. 

Very few of our communities have road access so many of our patients rely on air links to fly them from their homes to the ER at Stanton Hospital in Yellowknife.  As a result, our medivac and medical travel costs are the largest part of our healthcare budget. Much of my job consists of talking with nurses who staff health centers in these small communities to whom I provide medical advice, transportation decisions and moral support. 

Our population is also very young.  I trained in large centers in southern Canada where seeing a pediatric patient could be a rare and often anxiety provoking experience.  In the north I often feel like I work in a pediatric ER where most of my sickest patients are kids.

My colleagues and I are hopeful that the TREKK initiative will help bridge the gap between the remote periphery and the large urban center. There are many very dedicated nurses and physicians working all across Canada’s North who have many of the tools but lack the cutting edge knowledge that may be available in the large urban centers. 

In the NWT, even the smallest most isolated communities now have access to the Internet.  We’re hoping that TREKK will support not only our Yellowknife ER staff but also the health center nurse working alone and caring for sick children in these small remote communities.

Looking forward to what lays ahead.

Dave

From team: News and Events


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TREKK update from Terry Klassen

March 21, 2013

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

tags: Emergency Medicine Evidence-Based Medicine Pediatrics Research    

Links

Link to doc2doc.bmj.com commentary

http://www.evidencelive.org/


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