JMIR Publications

ABSTRACT

Background:

While COVID-19 dramatically increased virtual care uptake across many health settings, it remains significantly underutilized in urgent care.

Objective:

This study evaluated the implementation of a pilot virtual emergency department (VED) at an Ontario hospital that connected patients to emergency physicians through an online portal.

Methods:

This evaluation utilized a multi- methods approach informed by the RE-AIM framework. Data included semi-structured interviews with patients and physicians as well as post-visit surveys from patients. Interviews were transcribed and analyzed using thematic analysis. Data from the surveys were described using summary statistics.

Results:

Patients reported that the VED provided high-quality, timely access to care and praised the convenience, shorter appointments, and benefit of the calm, safe space afforded through virtual appointments. There was broad initial uptake of VED shifts among ED physicians with 60% completing shifts in the first two months and 42% completing one or more shifts per month over the course of the pilot. The VED was implemented using an iterative staged approach with increased service capabilities over time, including access to ultrasounds, virtual follow-ups after a recent emergency department visit, and access to outpatient blood work and urine tests (at the hospital or a local community laboratory) and x-rays. Physicians recognized value in supporting patients by advising on the need for an in-person visit, booking a diagnostic test, or referring them to a specialist.

Conclusions:

The VED had the support of physicians and facilitated care for low acuity presentations with immediate benefits for patients. It has the potential to benefit the health care system by seeing patients virtually and guiding patients to in-person care only when necessary. Long-term sustainability requires a focus on understanding digital equity and enhanced access to rapid testing/investigations. Clinical Trial: N/A