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

Abstract

The majority of children requiring emergency care are treated in general emergency departments (EDs) with variable levels of pediatric care expertise. The goal of the Translating Emergency Knowledge for Kids (TREKK) initiative is to implement the latest research in pediatric emergency medicine in general EDs to reduce clinical variation.

Objectives

To determine national pediatric information needs, seeking behaviours, and preferences of health care professionals working in general EDs.

Methods

An electronic cross-sectional survey was conducted with health care professionals in 32 Canadian general EDs. Data were collected in the EDs using the iPad and in-person data collectors.

Results

Total of 1,471 surveys were completed (57.1% response rate). Health care professionals sought information on children’s health care by talking to colleagues (n=1,208, 82.1%), visiting specific medical/health websites (n=994, 67.7%), and professional development opportunities (n=941, 64.4%). Preferred child health resources included protocols and accepted treatments for common conditions (n=969, 68%), clinical pathways and practice guidelines (n=951, 66%), and evidence-based information on new diagnoses and treatments (n=866, 61%). Additional pediatric clinical information is needed about multisystem trauma (n=693, 49%), severe head injury (n=615, 43%), and meningitis (n=559, 39%). Health care professionals preferred to receive child health information through professional development opportunities (n=1,131, 80%) and printed summaries (n=885, 63%).

Conclusion

By understanding health care professionals’ information seeking behaviour, information needs, and information preferences, knowledge synthesis and knowledge translation initiatives can be targeted to improve pediatric emergency care. The findings from this study will inform the following two phases of the TREKK initiative to bridge the research-practice gap in Canadian general EDs.

Résumé

Contexte

La plupart des enfants ayant besoin de soins d’urgence sont traités dans des services des urgences (SU) généraux dotés, à des degrés variables, de spécialistes en soins pédiatriques. L’initiative Translating Emergency Knowledge for Kids (TREKK) a pour but l’application des résultats les plus récents de la recherche en médecine d’urgence pédiatrique dans les SU généraux afin d’atténuer les différences de soins cliniques.

Objectif

L’étude décrite ici visait à déterminer, à l’échelle nationale, les besoins d’information en pédiatrie des professionnels de la santé travaillant dans des SU généraux, leurs comportements dans la recherche d’information ainsi que leurs préférences quant à l’obtention d’information.

Méthode

Il s’agit d’une enquête transversale électronique, menée parmi des professionnels de la santé, dans 32 services des urgences généraux, au Canada. La collecte de donnée dans les SU s’est faite à l’aide de tablettes électroniques (iPad) et de consignateurs de données, en personne.

Résultats

Au total, 1471 questionnaires ont été remplis (taux de réponse : 57,1 %). La recherche d’information en pédiatrie par les professionnels de la santé se faisait principalement par les échanges verbaux avec des collègues (n=1208; 82,1 %), les visites de certains sites Web sur la santé ou en soins médicaux (n=994; 67,7 %) et le perfectionnement professionnel (n=941; 64,4 %). Les ressources préférées des professionnels de la santé en matière de soins pour enfants comprenaient les protocoles et les traitements acceptés concernant des maladies courantes (n=969; 68 %), les cheminements cliniques et les guides de pratique clinique (n=951; 66 %) ainsi que l’information fondée sur des données probantes au sujet de nouveaux diagnostics ou de nouveaux traitements (n=866; 61 %). Les traumas multiples (n=693; 49 %), les traumatismes crâniens graves (n=615; 43 %) et la méningite (n=559; 39 %) se sont révélés les domaines dans lesquels les professionnels de la santé avaient besoin d’information clinique supplémentaire en pédiatrie. Enfin, les moyens préférés des professionnels de la santé pour recevoir de l’information sur les soins en pédiatrie étaient le perfectionnement professionnel (n=1131; 80 %) et les résumés imprimés (n=885; 63 %).

Conclusions

C’est par la compréhension des comportements des professionnels de la santé dans la recherche d’information, de leurs besoins d’information et de leurs préférences quant à l’obtention d’information qu’il est possible de cibler des initiatives de synthèse des connaissances et d’application des connaissances, et ce, dans le but d’améliorer les soins d’urgence en pédiatrie. Les résultats de l’étude guideront les deux phases suivantes de l’initiative TREKK afin de combler les écarts qui existent entre la recherche et la pratique dans les SU généraux au Canada.

INTRODUCTION

The majority of pediatric emergency cases are managed in general emergency departments (EDs) without an exclusive pediatric focus. ¹ Difficulties in accessing pediatric resources and training are barriers to providing optimal care in these settings and result in practice variation. ² Evidence shows that as many as 40% of children cared for in general EDs do not receive treatments for which clear evidence exists, and up to 20% of these children receive treatments shown to provide no benefit or sometimes harm. ^{3 - 7} Internationally, there is lower adherence to established clinical guidelines and poorer health outcomes for children seeking emergency care in non-pediatric centres. ⁸ To bridge the research-to-practice gap and raise the overall standard of care in pediatric emergency medicine, it is imperative to support knowledge mobilization within general EDs.

A 2007 report from the Institute of Medicine ⁹ provides three recommendations to improve pediatric emergency care, which are to 1) increase pediatric training (p.173); 2) develop evidence-based clinical practice guidelines for pediatric emergency care (p.175); and 3) provide pediatric leadership in EDs (p. 177). The Translating Emergency Knowledge for Kids (TREKK) is a pan-Canadian initiative supported by the Networks of Centres of Excellence – Knowledge Mobilization (NCE-KM) initiative. The goal of TREKK is to create a sustainable network between front-line clinicians working in Canada’s general EDs and Canadian pediatric emergency medicine specialists (e.g., Pediatric Emergency Research Canada and Knowledge Translation Canada members). Drawing on national and international expertise in pediatric emergency medicine and knowledge mobilization, TREKK seeks to address the four recommendations outlined in the Institute of Medicine report to optimize patient outcomes and resource utilization.

The TREKK Needs Assessment was the first of three phases within the TREKK initiative. The purpose of the needs assessment was to determine the information needs, seeking behaviours, and preferences of health care professionals working in general EDs to effectively address knowledge and skill gaps and increase confidence to manage acutely ill and injured children. To understand front-line clinicians’ perspectives, an electronic survey was conducted in 32 of Canada’s more than 478 EDs. ¹⁰ (Note: Only 7 of 10 provinces were able to provide data on the number of emergency departments in each province.) Based on the results of phase one, the second phase of TREKK will synthesize key research knowledge in pediatric emergency care, and the third phase will focus on the dissemination of synthesized knowledge through knowledge translation interventions, products, and tools.

METHODS

Study design and population

A cross-sectional survey was conducted in a convenience sample of 32 Canadian general EDs in urban, rural, and remote regions across nine provinces and one territory. Three to five sites were recruited and invited to participate by each of the 12 Canadian pediatric tertiary centres. Research ethics and operational approvals were obtained from all institutions, health regions, and/or hospital authorities before data collection commenced (n=39 individual approvals). ¹¹ Health care professionals working in the participating EDs were recruited using census sampling from May 2012 to October 2013.

Survey content and administration

Survey content was developed through an iterative process with the research team, which included pediatric emergency medicine clinicians, as well as experts in knowledge translation and information science. ¹² The 25-item survey was initially developed in English and translated into French to ensure that participants could complete the survey in either official language. A Canadian company specializing in online data collection instruments (Nooro Online Research, Barrie, ON) was contracted to create an interactive, electronic platform for the survey. Given the clinical environment in which data collection took place, this platform had to include a mechanism to collect and store data offline (i.e., without a wireless or 3G/4G connection), and to automatically upload data to a secure Canadian server once a wireless connection was established. Data were collected through the iPad; therefore, the survey’s functionality and design sought to capitalize on the tablet’s touch screen technology to foster participant engagement. Question formats included single- and multi-touch responses, sliding scales, and drag-and-drop boxes in which responses could be selected and rank-ordered. ¹² The electronic survey underwent several iterations; face validity and construct validity were determined through team meetings, and the survey was piloted within the research team prior to finalizing the electronic data collection instrument.

Data collectors were trained in data collection procedures, and research protocols were developed to ensure consistency. Data collectors traveled to each of the participating sites over the course of 17 months. They approached ED staff to describe the TREKK Needs Assessment and solicit participants. When a health care professional expressed interest in the survey, the data collector provided them with an iPad to review the consent form; if consent was indicated on the iPad, the participant automatically proceeded to the survey. Data collectors were available in the ED to answer questions and to assist with survey completion (e.g., technology-related issues) when requested. A full description of the survey development process and data collection methods has been described in a separate publication. ¹²

Data analysis

Survey data were downloaded from a secure Canadian server to MS Excel (2010) for data cleaning. To be included in the analysis, surveys had to meet the following criteria: 1) consent was indicated; 2) the participants’ province and/or TREKK site where they worked was provided; 3) the demographics section of the survey was completed; and 4) at least one question related to the participants’ information seeking behaviour, information needs, and/or information preferences was completed. Surveys that did not meet the inclusion criteria were deleted from the SPSS database. Additional data cleaning measures included recoding survey variables into categorical variables and comparing survey response options to free text responses (i.e., “other” open text responses) and recoding when appropriate. Descriptive statistics and frequencies were analysed with SPSS (v.21).

RESULTS

Results are presented as overall (national) analyses in four sections: 1) participant demographics; 2) current information seeking behaviour; 3) information needs; and 4) information preferences to reflect the multidisciplinary nature of ED staff. Other manuscripts (currently nearing submission for peer review) analyse these data according to professional group (e.g., doctor, nurse, allied health) and geographic area (urban, rural, remote setting).

Of 2575 potential participants working in the TREKK sites, 1768 health care professionals reviewed the information sheet on the iPad (68.7% of total staff), 1561 individuals consented to participate (57.1% of total staff, 88.3% of staff who reviewed the information sheet), and 1471 surveys were included in the final analysis (94.2% completion rate) (Table 1). The median number of surveys per ED was 44 (minimum 1, maximum 158). Surveys were completed by 1032 (70.2%) nurses, 304 (20.7%) physicians, 89 (6.1%) allied health professionals, and 46 (3.1%) other ED health professionals.

Table 1 Demographic characteristics

Current information seeking behaviour

Participants described their current approaches, including the specific sources and devices used to find information related to working with children in the ED. The median number of hours spent looking for and reading any new information each week overall was 2.00 hours (IQR=1.00–5.00). The median number of hours spent looking for and reading new information related to children’s health care each week was 1.00 hours (IQR=1.00–2.00).

Participants used a range of information sources in their work, including talking to colleagues (82.1%, n=1208), visiting specific medical/health websites (67.7%, n=994), professional development opportunities (64.4%, n=941), searching on the Internet search engine (62.5%, n=920), printed resources (60.9%, n=896), academic/professional journals (50.5%, n=743), social media (12.5%, n=184), and other resources (1.6%, n=23). Based on these data, the reliance on colleagues for gaining new information was remarkable, and academic or professional journals were ranked surprisingly low. Of note, desktop computers were the primary device for accessing information in the workplace environment (91.4%, n=1312) with smartphones ranked second (50.8%, n=730), despite participants’ home use of other platforms in much higher numbers: laptop computer (58.8%, n=844), smartphone (51.6%, n=740), desktop computer (49.3%, n=707).

Information needs: content and tools

Participants were asked to identify the types of information needed that are currently not available to them to provide the best care to children in the ED. The top four resources or tools identified focused exclusively on clinical information needs (Table 2). An important proportion of respondents needed information on strategies for managing children and families in the ED and to guide patient interaction (Table 2).

Table 2 Information resources/tools needed that are currently not available

Participants were also asked about specific clinical information needs related to pediatric conditions. The top five clinical information gaps identified were for the following conditions (Table 3): multisystem trauma, severe head injury, meningitis, the first presentation of congenital heart defects, and status epilepticus.

Table 3 Clinical information needs

Information source preferences

Participants indicated ways to receive new information to care for children in the future (Table 4). Professional development opportunities were selected most frequently, followed by printed summaries, talking to colleagues, and email. Websites were identified as the fifth preferred method of receiving new information; the top categories of preferred websites for receiving new information are point-of-care websites (n=47, 11.9%) and hospital/health region websites (n=39, 9.8%).

Table 4 Preferred information sources for new information

DISCUSSION

This was the first national needs assessment conducted in Canadian EDs focused on information needs, seeking behaviours, and preferences specific to pediatric care. Our findings demonstrate that emergency clinicians want more evidence-based, practical pediatric resources (i.e., protocols, pathways, summaries) and professional development opportunities. They also want additional information on clinical conditions, including multisystem trauma, severe head injury, and meningitis. Of note, information on talking to children and families about the child’s condition, particularly in situations of stress or crisis, is valued.

Our findings mirror results from Gilleland et al. ¹³ in which health care professionals identified information needs relating to high-anxiety-producing conditions (e.g., multisystem trauma); in their study, head injury and trauma were the second-ranked clinical information need. ¹³ Gilleland et al. ¹³ also demonstrated that health care professionals in community hospitals experienced many barriers to implementing research in practice, including lack of time. From these barriers, preferences for how to receive new information can be inferred.

The information needs of health care professionals have long been investigated. A number of studies have demonstrated that colleagues are nurses’ preferred knowledge sources, ^{14 - 18} regardless of rural or urban setting. In terms of physicians’ information-seeking behaviours, a recent narrative review highlighted six studies in which printed text sources were the top-ranked need, followed by human sources and electronic sources, ¹⁹ while another synthesis identified text sources as the top-ranked source in 13 of 19 studies, followed by information from colleagues, which was identified as the primary information source in four studies. ²⁰ This difference with our findings, where talking with colleagues and websites were top-ranked current information sources (see Table 2), may be due to physician representation in our study (20.7% of total sample) or the different time periods of the research (e.g., review studies occurring from 2002–2005; our research concluding in 2013). Over this period, there has been a substantial increase in the utilization and accessibility of digital platforms for information. The emphasis on digital information sources parallels findings from a study examining information-seeking behaviour in hospital-based pediatricians whose results suggested that the Internet was the most frequent information source for 67% of participants. ²¹

The identification of high-anxiety pediatric conditions as important aligns with previous research. Simon & Sullivan ²² identified that over 25% of community emergency practitioners were uncomfortable performing lifesaving pediatric procedures. ²² Another study using qualitative methods to explore education needs of non-pediatric hospital ED providers demonstrated that lack of experience with high-anxiety conditions (e.g., multisystem trauma, head injury) created uneasiness. ²³

Our findings highlight the significant time spent searching and reviewing new information; on average, practitioners spent nearly 200 hours per year. However, information overload and complexity are real concerns faced by health care professionals, ^{24 , 25} which means that the time spent with information searching/reviewing is likely inadequate to keep abreast of new developments. The burgeoning amounts of new knowledge and lack of available time indicate the need for developing tools or interpersonal strategies to manage this gap.

LIMITATIONS

Data collection using consensus sampling is not designed to be nationally or internationally representative. Methods for data collection were designed to overcome potential barriers, such as access to the clinical environment, busyness of health care professionals and technological constraints. Furthermore, self-reported data have inherent limitations and may not align with actual need.

CONCLUSIONS

This project is the most comprehensive national needs assessment performed in general EDs in Canada to date. Our findings highlighted that, on average, ED health care professionals spend 2 hours a week looking for and reading new information related to their professional responsibilities. Respondents reported that they heavily relied on colleagues to receive knowledge, yet they would prefer to get new information by way of professional development opportunities, printed summaries, and talking with colleagues. Furthermore, respondents identified high-anxiety pediatric conditions – multisystem trauma, severe head injury, and meningitis as clinical information gaps. These findings will inform the knowledge synthesis and implementation phases of TREKK and help establish research and knowledge translation priorities in pediatric emergency medicine.