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Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory.

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Virtual emergency departments (EDs) show potential, but physician integration varies. Some physicians normalized virtual EDs, citing patient satisfaction, while others faced barriers due to underutilization and unresolved patient issues.

Keywords:
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Area of Science:

  • Digital Health
  • Health Services Research
  • Emergency Medicine

Background:

  • The COVID-19 pandemic accelerated virtual health care adoption, but its role in urgent care settings remains under investigation.
  • The first virtual emergency department (ED) in the Greater Toronto Area was piloted in December 2020 at Sunnybrook Health Sciences Centre.
  • This initiative connected patients with emergency physicians via an online portal.

Purpose of the Study:

  • To investigate the integration of a virtual ED alongside traditional in-person emergency department operations.
  • To understand the experiences and perspectives of emergency physicians working within a virtual ED model.

Main Methods:

  • Semistructured interviews were conducted with 14 emergency physicians who had worked in the virtual ED.
  • The Normalization Process Theory (NPT) framework guided the interviews and data analysis.
  • Data analysis involved a combination of inductive and deductive techniques informed by the NPT.

Main Results:

  • Physician experiences were divided into two groups: those who normalized virtual ED practice and those who encountered barriers.
  • Physicians who normalized the virtual ED perceived patient benefits and were motivated by patient satisfaction.
  • Physicians facing barriers felt their skills were underutilized, experienced frustration with limited examination capabilities, and noted unresolved patient issues.

Conclusions:

  • Successful integration of virtual EDs requires addressing physician skill set evolution and ensuring satisfaction with care delivery.
  • Efficient technology and processes are crucial for the sustained adoption of virtual care models in emergency medicine.
  • Further research is needed to optimize virtual care delivery in urgent and emergency settings.