Treatment guidelines and children’s health
Dr. Shannon Scott studies how research evidence can be used to improve pediatric health care.
Story by Tara Narwani/Photo by Veer
The healthcare system in Canada is under threat by a number of factors: costs are rising due to Canada’s aging population and an increased pace of technological development; also, healthcare delivery is being undermined by overburdened emergency departments and excessive wait times for specialty services.
According to University of Alberta nursing professor Dr. Shannon Scott, significant healthcare savings and improvements in health outcomes could be achieved if knowledge generated from health research in Canada was more effectively used in clinical settings. However, the challenge lies in the complex process of transferring knowledge from researchers to healthcare providers, a process known as knowledge translation (KT).
New knowledge from health research doesn’t automatically lead to changes in patient care, explains Dr. Scott. “We have to create environments, understand attitudes and values to put knowledge to work.”
To illustrate the importance of KT, Dr. Scott describes a 2004 study, which was conducted by another nursing researcher, that examined how nurses put newborn babies to sleep. When surveyed, 72% of the nurses correctly answered that babies should be laid on their backs to sleep. Previous research has shown that this position reduces the risk of sudden infant death syndrome. However, when asked to self-report on how babies were actually put to sleep, only 30% of the nurses put the babies on their backs.
“In that study, 72% of nurses knew what the correct research evidence suggested. Yet, 42% weren’t using it,” says Dr. Scott.
In her work, Dr. Scott examines how the work environment of healthcare professionals affects the way individuals use available knowledge. A variety of factors—such as the degree of organizational support for a particular initiative—can encourage or discourage the use of new clinical practices.
Dr. Scott is currently investigating the implementation of new clinical practice guidelines for acute gastroenteritis and croup in a range of healthcare settings across the province. Acute gastroenteritis and croup are two of the top three reasons why children visit an emergency department. Acute gastroenteritis is associated with vomiting and diarrhea, and children suffering from croup have a bark-like cough and can experience severe respiratory distress.
Despite the availability of clear evidence-based treatment protocols for both conditions, research shows there’s considerable variation in how the diseases are treated. Healthcare professionals often act on the basis of their previous training or experience rather than on the latest research evidence.
The goal of these two new clinical practice guidelines being introduced in Alberta is “to decrease treatment variation and help healthcare professionals make decisions about healthcare treatments,” explains Dr. Scott. “If my son had croup and I brought him into the Stollery Children’s Hospital, the hope would be that the treatment prescribed there would be similar to the treatment he’d receive at the Alberta Children’s Hospital.”
The clinical practice guidelines for croup and gastroenteritis will be introduced to 16 locations throughout the province, including 12 emergency departments in both rural and urban settings. Dr. David Johnson from the University of Alberta, Dr. Scott’s collaborator on the study, will run educational seminars at each site to present the new guidelines.
Dr. Scott’s research will focus on four of these sites. She will administer surveys to understand how each site is organized and what resources are available to implement the new guidelines. She will run focus groups prior to Dr. Johnson’s seminars to understand how the personnel perceive the potential for success of the new guidelines. After implementation, Dr. Scott will attempt to gauge, again with focus groups, if the guidelines were successful or not, and why.
This type of qualitative research is very labour intensive. But from Dr. Scott’s perspective, it’s vital. “We need to understand the variation in uptake of a new guideline. Once we understand the factors that influence this variation, we can optimize and prepare healthcare settings for change. Ultimately, we hope for full adoption of research-based change.”
For more information on Dr. Scott’s research, follow her on twitter: @echoKTresearch.