JMIR Publications

ABSTRACT

Background:

British Columbia has over 200 rural, remote, and Indigenous communities that have limited healthcare resources due to physician isolation, sparsity in clinical resources, lack of collegial support, and provider burnout. Real-Time Virtual Support (RTVS) peer-to-peer pathways provide support to patients and providers. Amidst the COVID-19 pandemic exacerbating existing healthcare disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities.

Objective:

We highlight the story of Rural Urgent Doctor in-Aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021.

Methods:

This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. We explored the perspectives of the DCDH and RUDi provider experiences by utilizing purposive sampling from stakeholder groups and conducting semi-structured interviews. Content analysis was used to identify themes that emerged from the interviews.

Results:

By acting as most responsible providers (MRP) during overnight ED shifts, RUDi prevented the closure of the DCDH ED and diversion of patients to another rural hospital. RUDi physicians covered 39 overnight shifts and were MRP for 245 patients that presented to the DCDH ED. Seventeen interviews with key informants revealed important themes related to: leadership and relationships as facilitators of the coverage’s success, the experience of virtual physician support, providing a “safety net,” finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings demonstrated tangible ways that this model of virtual support can be improved in future cases.

Conclusions:

Rapid co-development and implementation of virtual solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural ED to ease pressures of physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis.