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‘No matter where a child goes’: Lisa Knisley and TREKK are improving emergency care for kids at hospitals

TREKK organization provides specialized knowledge to ensure young patients get the best treatment

By Laura Eggertson
February 27, 2023
Erin Hill, Children’s Hospital Research Institute of Manitoba
“A lot of the people using TREKK are helping to drive change within their departments are nurses — the nurse managers, the nurse educators,” Lisa Knisley says. “They are the ones who are looking to us to help to provide the education.”

In the midst of her father’s lengthy illness, the kindness of nurses sustained Lisa Knisley.

Knisley was 15 when her father entered hospital for treatment of a brain tumour. During the six years before he died, Knisley encountered “hundreds” of nurses and other health-care professionals, she says.

Almost 30 years later, the memories of a handful of nurses who inspired the then-frightened and grieving teenager’s decision to become an RN herself remain sharp.

Those nurses explained each step of their care of her dad. They asked Knisley’s opinion about his treatment. They enlisted her to hold equipment, giving her a sense of control in an uncontrollable situation.

Most importantly, they shared their stories. One nurse told Knisley about losing her own parents.

“That was helpful,” says Knisley, now a 49-year-old PhD candidate and the executive director of Winnipeg-based TREKK (Translating Emergency Knowledge for Kids). “I knew they were super busy, but I always felt they had time. They cared for my dad and they cared for me.”

Getting the right care for children and youth in hospital emergency departments throughout Canada is the heart of Knisley’s role at TREKK.

Improve care

The national non-profit organization develops evidence-based tools, resources and training for nurses and other health-care providers at emergency departments across the country.

TREKK’s mission is to make sure children and youth who arrive at rural, remote or general hospitals receive the same high-quality, standardized care they would get at specialized pediatric institutions.

About 80 per cent of children who arrive at emergency departments in Canada are treated at general hospitals, Knisley says. That reality means doctors and nurses may see particular illnesses or symptoms, which present differently in children, infrequently.

They may not be up-to-date on the latest pediatric best practices.

“It’s a vast specialty,” Knisley says. “No matter where a child goes when they need emergency care, those first steps should be the same.”

If a child arrives with croup, an acute exacerbation of asthma, or diabetic ketoacidosis (which is treated differently in children than adults), for example, emergency health-care providers need the best treatment options at their fingertips.

Fill knowledge gap

“Nurses have said to us, ‘When a child comes through the door, it can be very scary’,” Knisley says. “They absolutely want to do the best they can, but it’s near to impossible to stay up to date on a whole vast array of emergency medicine.”

A network of pediatric and emergency physicians, nurses and researchers created TREKK to fill that knowledge gap. The information they produce bolsters the knowledge and confidence of emergency health-care providers so they can treat sick and injured children successfully.

Through an app and the organization’s website, nurses and other health-care professionals can download videos, 1-2-page primers with bottom-line recommendations and medication dosages, infographics, clinical guidelines and research papers.

When treating respiratory symptoms of croup, for instance, which are triggered by a viral infection in children aged six months to five years, TREKK’s bottom-line recommendations emphasize giving dexamethasone to all kids no matter how severe their croup presents. The medication can reduce repeat visits to the emergency department and hospital admissions.

TREKK also offers resources for parents, coordinated by Knisley’s colleague Shannon Scott, another RN and PhD who was a co-applicant on the grant that helped the group create the organization in 2011.

Becoming the executive director of TREKK was a natural fit for Knisley. After growing up in Winnipeg and earning her bachelor of nursing at the University of Manitoba, she worked as a nurse in Texas and then Vermont before taking a three-month contract in the United Kingdom.

The contract turned into 15 years in Britain. Knisley provided acute-care nursing of adults with diabetes and cardiac conditions and worked with patients enrolled in clinical trials. She also earned her master’s in arts from the University of Westminster in London.

Promote connections

While in England, Knisley held leadership roles in projects to improve care for people with diabetes and standardize information for patients to help them make decisions about their care.

When Knisley, her husband Paul and her children William and Lewis were preparing to return to Canada to be closer to family, the TREKK position caught her eye.

“It was really an amazing opportunity to combine all my years’ experiences into one area and work with a very inspirational group of researchers across the country, at a national level,” Knisley says.

As executive director, one of Knisley’s jobs is to co-ordinate hands-on training sessions at hospitals. She also promotes connections between health-care providers at general hospitals with those at pediatric institutions.

Before the COVID-19 pandemic, TREKK had completed more than 120 in-person education sessions across Canada, including simulations in emergency departments. The organization is currently working on offering virtual training opportunities.

Over the last 11 years, TREKK has become a trusted resource for both families and emergency health-care providers, says Knisley. People around the world have downloaded the organization’s resources.

“People know they can come to TREKK, pull our resources, use them outright or help inform their local resources. They can trust them,” she says.

Change practice

Knisley is proud of TREKK’s work. Feedback from health-care providers lets her know they are making an impact.

“It’s important to understand how important TREKK is to us and how's its being integrated at the jurisdictional level … it is changing practice,” one rural emergency physician wrote the TREKK team.

Nurses also tell Knisley they feel more prepared after reviewing the TREKK information or participating in a training session. They are deeply involved in suggesting ways to improve emergency care for children.

“A lot of the people using TREKK are helping to drive change within their departments are nurses — the nurse managers, the nurse educators,” Knisley says. “They are the ones who are looking to us to help to provide the education.”

Although Knisley’s work is demanding, given the small number of paid staff at TREKK, she has an army of volunteers who create and review the resources the organization develops. When she’s not busy with TREKK, she takes time to recharge by watching movies and walking and running with friends.

“It’s been great even on those really cold days to be outside,” she says. “It’s a good combination of connection with nature, connection with friends, and moving my body.”

The work TREKK does to collect suggestions and feedback from nurses and other emergency professionals, and from families, inspires Knisley.

“There are people’s stories behind the data,” she says. “You need to share the stories, the lived experiences. That is a big part of what nurses can bring to this.”

Laura Eggertson is a freelance journalist based in Wolfville, N.S.