ED-UCATE: Partnering with Parents and Youth to Co-design Discharge Communication Interventions for Pediatric Emergency Care
Funding: CIHR Project Grant
Discharge communication in a pediatric emergency department can be a challenging time for parents, youth and clinicians. Most discharge communication interventions that have been evaluated in the literature target parents but few consider how the chaotic nature of an emergency department might impact communication. To date, parents and youth have not been involved in designing discharge communication interventions. Inadequate discharge communication can lead to poor health outcomes and can result in unnecessary return visits to the emergency department. We aim to evaluate a strategy for partnering with parents, youth and emergency department clinicians to co-design discharge communication interventions for asthma and minor head injury.
Implementation and evaluation of the Eat, Sleep, Console Model of Care for babies diagnosed with neonatal abstinence syndrome: A Scoping Review
“Infants diagnosed with neonatal abstinence syndrome [NAS] or neonatal opioid withdrawal syndrome [NOWS] is a growing population in Canada; experiencing unique health concerns and individualized needs. Current clinical practice guidelines demonstrate a clear knowledge gap of best-available evidence in the literature. In most facilities, an outdated model of care, the Finnegan Neonatal Abstinence Scoring Tool (FNAST), is used to guide the care and assessment of babies diagnosed with NAS. Challenges with the FNAST has prompted the transition to a novel approach to care for this population titled the Eat, Sleep, Console Model of care. Despite the promising intervention of the ESC model to improve patient and health system outcomes, little is known on how to effectively implement the model into clinical practice; along with evaluating its implementation in practice to ensure sustainability. Large changes in health systems, like the ESC model, are often not sustained in practice due to poor engagement in implementation and evaluation methods. As such, efforts are needed to understand how to systematically implement and evaluate the ESC model in health care practice, improving the success of implementation and sustainability of the model in practice. (Gallant et al., 2022)”
Preprint for scoping review protocol: http://hdl.handle.net/10222/81989
Pediatric to adult transition of care educational programs and toolkits for healthcare providers: a scoping review
This scoping review aims to address two objectives: (1) Map and characterize the existing literature to date on educational and training programs for healthcare providers to support the transition from paediatric to adult care and (2) Describe the barriers and facilitators to implementing these programs.
This scoping review seeks to identify the key concepts, theoretical underpinnings and conceptual boundaries that underpin the educational and training programs of transitions of care, as well as to clarify what is within these programs, what is missing, what theory they are based on in health literacy, what is the system of coordination and collaboration and what providers are involved. The ability to compare training programs is important given the growing body of literature that highlights poor clinical outcomes for patients' post-transfer due to insufficient provider education and the need for optimal education for practitioners on how to navigate the transitionary period leading up to adult-centred care. By pooling data and categorizing outcomes, the most useful outcomes can be used broadly, which can provide more powerful training and education programs to better support the providers, families and the wholistic transition of care process.
Integrated Knowledge Translation Co-Design Study: An Environmental Scan
Funding: Nursing Research and Development Fund
There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programs, and policies. However, most graduate students do not receive formal training in collaborative health research approaches. As such, we completed an environmental scan of all available documents and/or resources for graduate students to build a foundational knowledge on the resources that are currently available for graduate students and trainees in health research. Findings from this study will be used to guide a co-design event with key stakeholders to develop comprehensive guidelines for graduate students to engage in an integrated knowledge translation approach to health research.
This study builds on a previous scoping review on trainee experiences using an IKT approach to research, available here.
Integrated Care Study
Funding: Research NS
The health care system is facing challenges related to poor quality of care, rising health care costs, and outdated technology. Efforts are needed to redesign health services to improve outcomes for patients, health care providers, and the overall health system. One way to address these challenges is to integrate care across multiple health care providers and services. This means that care is coordinated to meet patient needs and preferences. Integrated models of care help to improve the quality of care, quality of life, patient satisfaction, and health system efficiency. The goal of this research study is to work with patients, families, health care providers, and health system administrators to co-design recommendations for an integrated model of care for pediatric inpatient-ambulatory care services at the IWK Health Centre.
Knowledge Translation Sustainability
The implementation of evidence-based interventions (EBIs) in healthcare is meaningless without long-term sustainability efforts that aim to ensure the lasting benefits of EBIs for patient outcomes. Knowledge translation (KT) strategies such as audit and feedback, facilitation, opinion leaders and educational outreach are used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are being used to support the long-term sustainability of EBIs in institutional healthcare settings. With colleagues at University of Alberta, we are conducting a scoping review to examine the current evidence on: i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; ii) barriers and facilitators to the use of KT strategies for sustainability; iii) reported implementation outcomes of KT strategies used for sustainability and iv) the reported sustainability outcomes of EBIs
Evaluation of a Patient Managed Tool to Improve Discharge Communication in Emergency Practice Settings
Funding: IWK Health TRIC Grant
More than 90% of people who visit an emergency department (ED) are discharged home, and given information for their continued care at home. Good communication between healthcare providers and patients/caregivers is essential to ensure that this information is understood. However, that is often not the case. Research on discharge communication in EDs so far has targeted either patients and/or caregivers with minimal consideration of the environment in which the communication occurs. In addition, there has been very limited development of co-designed tools prior to implementation. Our service partners are committed to the involvement of patients and families in the design, implementation and evaluation of health services. Our team of patients, caregivers, clinicians and researchers have used a theory-based co-design approach to develop a patient managed communication tool to improve recall and comprehension of important discharge information shared during an emergency department visit. The communication tool has been evaluated for its usability and acceptability by these stakeholders. The current phase of the project is feasibility testing, where the tool will be used at IWK Health and 3 other health centres in Nova Scotia. The data gathered will allow us to develop an implementation strategy for scale up and sustainability in Nova Scotia.
Understanding Children with Medical Complexity in the Maritime Provinces
Funding: CIHR Project Grant
Children and youth with complex care needs are one of the most vulnerable populations served by our pediatric health and social care systems. Prior to the COVID-19 pandemic, caregivers of children with complex care needs reported numerous gaps in programs and services including a lack of care coordination and communication between service providers. The COVID-19 public health measures resulted in a high volume of rapid change in the supports available across the Maritime Provinces. This project aims to understand how the COVID-19 public health restrictions and service changes impacted the health and well-being of children with complex care needs and their families in the Maritimes. We intend to highlight innovative practices and areas for improvement and translate this understanding into recommendations for policy reform.
Co-design of a Patient/Caregiver Discharge Communication Tool for Emergency Practice Settings
Funding: CIHR Catalyst Grant
Most people who visit an emergency department will be discharged home at the end of their visit with information on how to manage their care at home. Good communication between healthcare providers and patients or their caregivers is critical to ensure important information is shared and understood throughout the emergency department stay. However, patients and/or caregivers often leave the emergency department without receiving or understanding all of the information required to achieve optimal health. To date, strategies to improve discharge communication in emergency departments have primarily targeted patients and/or caregivers with minimal consideration of the environment in which the communication occurs. Further, patients and/or caregivers have rarely, if ever, been involved in the design or evaluation of discharge communication tools prior to implementation. According to the Institute of Medicine, health literate organizations assess barriers to information exchange and enable people to access and use health information and services. Our service partners are committed to the involvement of patients and families in the design, implementation and evaluation of health services. Our team of patients, caregivers, clinicians and researchers have used a theory-based co-design approach to develop a patient managed communication tool to improve recall and comprehension of important discharge information shared during an emergency department visit. The aim of our project is to evaluate our communication tool to determine its usability and acceptability by patients, caregivers and emergency department healthcare providers. The focus of this project will be on children who are within the urban centers treated at tertiary care facilities. We will use our findings to refine the communication tool and develop an implementation plan for a future multi-site trial with emergency departments across Canada.
Use of a Learning Health System Framework to Examine Quality and Safety Improvement at the IWK Health Centre During COVID-19
Funding: Nova Scotia COVID-19 Health Research Coalition
The COVID-19 pandemic has caused health care organizations to make rapid changes to the way they deliver care to patients and families. There have been huge shifts across the health system to ensure the quality and safety of health care during this challenging time. The IWK Health Centre has responded quickly to COVID-19 by making changes to the way care is delivered, including changes to policies and physical space, canceling non-essential surgeries, and moving staff to different areas of the health centre to meet the changing needs. A Learning Health System is a framework that promotes repeated cycles of learning and improvement to ensure we are using best practices in health care delivery. A Learning Health System framework can provide a clear structure for improving care in response to a global pandemic. The goal of this study is to use a Learning Health System framework to examine the IWK Health Centre COVID-19 pandemic planning and identify strategies that we can use to be prepared for future pandemics. We will examine several sources of data, including health administrative data, interviews with staff and patients from the IWK Health Centre, and pandemic planning documents, to answer our research questions. We will organize the findings using the Learning Health System framework to give us a clearer picture of how the IWK Health Centre has responded to COVID-19. We will work with IWK Health Centre staff and patients to review the findings and identify strategies that would be useful. The findings from this study will be important for planning and responding to future pandemics.
Transitions in Care Study
Funding: IWK mentored grant & MSSU Priority Project
Transition processes have varied approaches across health systems. There are few approaches have been systematically developed or evaluated. Our research aimed to understand local barriers and enablers to transition of care for youth transferring from pediatric to adult care and the impact of transfer on health and health system outcomes. Patient and family collaboration was instrumental in our project and its design. Across our data with youth, providers, and caregivers there were some similarities including but not limited to gain knowledge and skills, need resources and balancing independence with support. Our findings have helped to advise future work in many capacities within transition practices from pediatric to adult health care.
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Exploring Respite Care for Children with Medical Complexity and their Families in Nova Scotia
Respite care is an essential health service for children with medical complexity and their families to support a successful transition from hospital to community-based care. Respite care is often conceptualized as providing a break to caregivers from caregiving demands, while also providing time for those being cared for to interact with individuals outside of their usual caregiving unit. Previous research exploring respite care programs for families of children with medical complexity has revealed a number of potential models of care. However, there has yet to be one ideal model of care recognized to support respite care delivery for this population. The overall goal of this project is to gain an increased understanding into the experiences and needs of children with medical complexity and their families seeking access to respite care services in Nova Scotia. The objectives of this research are to: (1) Describe the experiences of Nova Scotian families with children with medical complexity seeking respite care services; (2) Identify the barriers and enablers to accessing respite care services in Nova Scotia; (3) Identify the key components to a successful pediatric respite care strategy for Nova Scotian families of children with medical complexity.
PED-UCATE: Pediatric Emergency Department Use of Communication Technologies to Activate Transitions Home Effectively
Funding: CIHR Operating Grant
Most people visiting the emergency department will leave the hospital and return home to manage their own medical condition. Communication between healthcare providers and patients or their caregivers during these visits can impact patient outcomes. Miscommunication of important information can lead to negative health problems. To date, strategies to improve discharge communication in emergency department have primarily targeted patients and/or caregivers with minimal consideration of the context in which the communication occurs. Further, patients and/or caregivers have rarely, if ever, been involved in the design or evaluation of discharge communication tools. According to the Institute of Medicine, health literate organizations are healthcare organizations that remove barriers and enable people to access and use health information and services. As a health literate organization, we have committed leadership at the health service leave and involvement of patients and families in the design, implementation and evaluation of the services that we provide at IWK Health Centre. Our team of patients, caregivers, clinicians and researchers used a theory-based co-design approach to develop a patient/caregiver managed communication tool prototype to improve recall and comprehension of important discharge information shared during an emergency department visit. The aim of our project is to evaluate the prototype of the communication tool with test users to determine its usability and acceptability by patients and caregivers as well as to see whether the tool can be adaptability to different emergency care settings. We will use our findings to develop the final product of our communication tool and come up with a research plan to apply for future funding opportunities for evaluating and implementing the tool in emergency settings across Canada.
Youth and Parent Engagement Scoping Review
Funding: NSHRF Development & Innovation Grant
Current evidence indicates patient involvement in health services research contributes to the creation of more accessible and acceptable services and improved relevance and acceptance of research findings. However, the literature examining youth and parent engagement in health care interventions is not well defined or organized and has yet to be systematically reviewed. This project will map the existing evidence describing parental engagement in designing healthcare interventions for pediatric tertiary care.
Building a Strategy to Support Parent and Youth Partnership in Patient-Oriented Research in the Maritimes
Research Coordinator: Lauren MacEachern
Funding: CIHR Patient-Oriented Research Collaboration Grant
Partnerships between youth, parents and health care professionals can improve outcomes for children and youth. However, best practice evidence to support partnerships between youth, parents and researchers in child-oriented research is less robust. Methods for including parents and youth in health research in the Maritimes vary widely, with little infrastructure available to guide meaningful engagement. Mechanisms and processes are urgently needed to support the inclusion of parents, children and youth as partners in child health research. The overall goal of our project is to co-develop a strategy, with input from parents, patient engagement experts and members of the research community, to support parent-researcher partnerships in patient-oriented research in the Maritimes. Our project outputs will build capacity for patient-oriented research in a child health context.
Research Coordinator: Christine Cassidy
Funding: IWK/NSHA TRIC Grant
The PrEPP study will implement a patient and parent expectation (PrEPP) questionnaire at 4 emergency departments in Nova Scotia to explore emergency department productivity, resource utilization and patient satisfaction with care. This study consists of 3 phases:
1) The PrEPP tool will be implemented in EDs for a 10-month period
2) We will reflect on the tool, examine our outcome measures and refine our implementation approach if necessary
3) We will re-implement the questionnaire into emergency departments
Exploring Provider-Caregiver Communications: An Observation Study
Research Coordinator: Andrea Bishop
Funding: CIHR Operating Grant
This multi-site study will determine whether clinicians include the essential content and process elements in discharge communication with caregivers. The study will also identify communication strategies and document caregiver recall and comprehension. The data collection methods used will include non-participant observation through the use of video recording, as well as chart audits and caregiver follow-up.
Publication(s): Understanding discharge communication behaviours in a pediatric emergency care context: a mixed methods observation study protocol
Complex Transitions of Care Study
Funding: IWK/NSHA TRIC Grant
Transitions in care for children and families with complex care needs to their home districts in Nova Scotia is not optimal. The current structures and processes result in an unnecessary burden to families and patients and the healthcare system. We will use an integrated mixed methods approach to examine the current structures and processes from a patient centered perspective. This study consists of 3 phases:
1) We will use a case study design to develop multiple cases to examine the transition experience for a range of children and families with complex care needs
2) We will conduct focus groups with health care providers and parents to identify barriers and facilitators for transitions in care
3) We will host a one day workshop for multiple stakeholders to discuss findings and develop an action plan
Publication(s): Strategies to support transitions from hospital to home for children with medical complexity: A scoping review
Regional/Community ED Discharge Communication Qualitative Study
Research Coordinator: Allyson Gallant
Funding: NSHRF Establishment Grant
This study is exploring the process, content, and barriers and facilitators of discharge communication in the context of pediatric emergency care in 10 Regional/Community emergency departments across Nova Scotia. In the upcoming months we will carry out one emergency clinician focus group, as well as 6-12 interviews with caregivers at each site.
Parent & Clinician Discharge Communication Qualitative Study
Funding: CIHR Operating Grant
This research is examining the process and content of discharge instructions in emergency pediatric care at 6 emergency care sites across Canada. At each site, one focus group with emergency room clinicians (8-12) as well as 12 interviews with caregivers, and 2 interviews with adolescent girls will be completed in the upcoming months.
REAL KT Curriculum
Funding: NSHRF Catalyst Grant
Knowledge Translation (KT) is the application of knowledge to help improve health care services and the health care system. Bridging the gap between research and practice is essential to ensuring that Nova Scotians are receiving the best health care possible.
The aim of this interactive curriculum is to build awareness of and capacity in KT activities in Nova Scotia and to provide the opportunity for research and decision-makers to work collaboratively. A series of workshops will be held to engage participants from different sectors of the health care system in Nova Scotia in a facilitated dialogue about KT. Local experts in KT will share current best practices regarding the use and implementation of KT science and practice.
REAL Change Intervention Workshop
Funding: NSHRF Catalyst Grant
The REAL Change Intervention Workshop is funded by the NSHRF and aims to bring small teams of stakeholders in the Nova Scotia health system and public health sector together to design and implement a practice or policy change. The teams benefit from the support of knowledge translation (KT) experts and KT coaches to guide through a systematic approach to designing and evaluating their practice or policy change. This support ensures their practice or policy changes are successfully implemented and have a lasting impact on population health.
Discharge Communication Delphi Study
Funding: CIHR Operating Grant
This Delphi Study identified content for inclusion which will aid to ultimately develop best practice guidelines for discharge communication for caregivers of children who present to the emergency department. Using a delphi study technique, emergency department physicians and nurses from across the country were surveyed to come to a consensus on the top 5 content items which should be communicated to all caregivers across six different illness presentations.
Publication(s): Essential Content for Discharge Instructions in Pediatric Emergency Care: A Delphi Study