BACKGROUND
COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care’s potential role remains unclear in the urgent care setting. In December 2020 the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health Sciences Centre by connecting patients to emergency physicians through an online portal.
OBJECTIVE
This study aimed to understand whether and how ED physicians were able to integrate a virtual ED alongside in-person operations.
METHODS
We conducted semi-structured interviews with ED physicians guided by Normalization Process Theory (NPT). NPT provides a framework to understand how individuals and teams navigate the process of embedding new models of care as part of normal practice. All physicians who had worked within the virtual ED model were invited to participate. Data were analyzed using a combination of inductive and deductive techniques informed by NPT.
RESULTS
A total of 14 physicians were interviewed. Participant experiences were categorized into one of two groups: one group moved to normalize the virtual ED in practice, while the other described barriers to routine adoption. These groups differed in their perception of the patient benefits as well as the perceived role in the virtual ED. The group that normalized the virtual ED model saw value for patients (coherence) and were motivated by patient satisfaction witnessed (reflexive monitoring) at the end of the virtual appointment. In contrast, the other group did not find virtual ED work reflective of the perceived role of urgent care (cognitive participation) and felt their skills as ED physicians were underutilized. The limited ability to examine patients and a sense that patient issues were not fully resolved at the end of the virtual appointment caused frustration among the second group.
CONCLUSIONS
As we move into a further digitally integrated system of healthcare it will be essential to support the evolution of staff skill sets to ensure physicians are satisfied with the care they are providing to their patients, while also ensuring the technology and process is efficient and clinicians can feel good about the care they provide.