The prolonged COVID-19 pandemic has created unique and complex challenges in operational and capacity planning for pediatric emergency departments, as initial low pediatric patient volumes gave way to unpredictable patient surges during Delta and Omicron variants. Compounded by widespread hospital supply chain issues, staffing shortages due to infection and attrition, and a concurrent pediatric mental health crisis, the surges have pushed pediatric emergency department leaders to re-examine traditionally defined clinical processes, and adopt innovative operational strategies. This study describes the strategic surge response and lessons learned by 3 major freestanding academic pediatric emergency departments in the western United States to help inform current and future pediatric pandemic preparedness.

Introduction: TREKK is a national knowledge mobilization network of clinicians, researchers and parents aimed at improving emergency care for children by increasing collaborations between general and pediatric emergency departments (ED). This study aimed to determine patterns of knowledge sharing within the network and identify connections, barriers and opportunities to obtaining pediatric information and training. Methods: Social network analysis (SNA) uses network theory to understand patterns of interaction. Two SNAs were conducted in 2014 and 2015 using an online network survey distributed to 37 general EDs. Data was analyzed using UCI Net and Netdraw to identify connections, knowledge sharing and knowledge brokers within the network. Building on these results, we then conducted 22 semi-structured follow-up interviews (2016) with healthcare professionals (HCPs) at General EDs across Canada, purposefully sampled to include individuals from connected and disconnected sites, as identified in the SNA. Interviews were analyzed by 2 reviewers using content and thematic analysis. Results: SNA data was analyzed for 135 participants across the network. Results from 2014 showed that the network was divided along provincial lines, with most individuals connecting with colleagues within their own institution. Results from 2015 showed more inter-site interconnectivity and a reduction in isolated sites over time from 17 to 3. Interview participants included physicians (59%) and nurses (41%) from 18 general EDs in urban (68%) and rural/remote (32%) Canada. HCPs sought information both formally and informally, by using guidelines, talking to colleagues, and attending pediatric related training sessions. Network structure and processes were felt to increase connections, support practice change, and promote standards of care. Participants identified personal, organizational and system-level barriers to information and skill acquisition, including resources and personal costs, geography, dissemination, and time. Providing easy access to information at the point of care was promoted through enhancing content visibility and by embedding resources into local systems. There remains a need to share successful methods of local dissemination and implementation across the network, and to leverage local professional champions such as clinical nurse liaisons. Conclusion: This study highlights the power of a network to increase connections between HCPs working in general and pediatric EDs. Findings reinforce the critical role of ongoing network evaluation to improve the design and delivery of knowledge mobilization initiatives.

Introduction: Within Manitoba, little is known about the current state of pediatric emergency department (ED) use or the state of provincial data collection. This study sought to gain a baseline understanding of pediatric ED use in Manitoba, including child demographics, visit characteristics, variation across the province, drivers of ED use, and data completeness. Methods: A retrospective cohort study was conducted using administrative data from the Manitoba Centre for Health Policy, and included all children aged 0-17 who presented to a Manitoba ED between 2011/12 and 2015/16, as identified from the Emergency Department Information System (EDIS), the National Ambulatory Care Reporting System (NACRS) and physician billing claims. Frequency of use was defined as single, intermediate (2-6 visits) and frequent (7+) and regional trends in child characteristics, ED use, acuity, presenting complaints, and discharge dispositions were observed. Ordinal logistic regression will be used to identify predictors of ED use. Results: Overall, we were able to capture 250,620 ED visits made by 172,306 children; data sources and completeness varied by year. Provincially, children under 5 years of age were the most frequent users of the ED, and use <1 year of age was highest in the North. We observed higher use among low-income children, particularly in rural mid and north, and few differences by sex. By year, the majority of children made single-use of the ED (64.48%), while fewer were classified as intermediate (34.40%) or frequent users (1.11%). Overall, the top presenting complaints were for fever (10.27%), limb complaint/trauma (7.48%), abdominal pain (5.75%), nausea and/or vomiting (4.53%) and shortness of breath (3.68%), with variation by triage level. In rural but not urban areas, mental health assessments were a top presenting complaint and primary reason for transfer to larger centres. Results of predictors of ED use are pending. Conclusion: Results from this study will provide important information about the predictors and variation of ED use by region and top causes for visit, enabling us to better tailor knowledge mobilization efforts and tool development to the local context. Identified gaps in data collection are important to address to advance our knowledge and delivery of pediatric emergency care at the provincial level.

Introduction: Optimal discharge communication between healthcare providers and parents who present to the emergency department (ED) with their children is not well understood. Current research regarding discharge communication is equivocal and predominantly focused on evaluating different delivery formats or strategies with little attention given to communication behaviours or the context in which the communication occurs. The objective of this study was to characterize the process and structure of discharge communication in a pediatric ED context. Methods: Real-time video observation and follow-up surveys were used in two academic pediatric EDs in Canada. Parents who presented with their child to the ED with one of six illness presentations, a Canadian Triage Acuity Score of 3-5 were eligible to participate. All ED physicians, learners, and staff members were also eligible. Provider-parent communication was analyzed using the Roter Interaction Analysis System (RIAS) to code each utterance. Parent health literacy and anxiety were measured upon admission to the ED. Parent recall of important discharge information and satisfaction with communication was assessed within 72 hours of discharge. Results: A total of 107 ED patient visits were video recorded and a total of 70,000 utterances were coded across six illness presentations: abdominal pain (n=23), asthma (n=7), bronchiolitis (n=4), diarrhea/vomiting (n=20), fever (n=27), and minor head injury (n=26). The average length of stay for participants was 3 hours, with an average of three provider interactions per visit. Interactions ranged in time from less than one minute up to 29 minutes, with an average of six minutes per interaction. The majority of visits were first episodes for the presenting illness (63.2%). Physician utterances coded most commonly involved giving medical information (22.9%), whereas nurses most commonly gave orientation instructions (20.9%). Learners were most likely to employ active listening techniques (14.2%). Communication that provided post-discharge instructions for parents comprised 8.5% of all utterances. Overall, providers infrequently assessed parental understanding of information (2.0%). Only 26% of parents recalled receiving important discharge information deemed relevant to their childs disposition. Yet, parent satisfaction with the amount of information communicated during the ED visit was generally high (89.6% agreed or strongly agreed). Conclusion: This is the first study of ED discharge communication to be conducted in a pediatric setting using video observation methods. Provider-parent communication was predominantly characterized by giving medical information, with little time devoted to preparing families to care for their child at home. Greater assessment of parent comprehension of discharge communication is needed to ensure that parents understand important instructions and know when to seek further care.