Implementing virtual urgent care services in emergency departments: a multi-site focus group study of adaptation and...

The Virtual Urgent Nova Scotia (VUNS) program was introduced to address emergency department (ED) overcrowding and improve access to urgent care through virtual health services. This study captures the perspectives, sentiment, and attitudes toward the implementation of VUNS from rural ED providers.

VUNS staff from seven different sites across the province of Nova Scotia were invited to focus groups to explore the implementation of VUNS in their local context. Focus groups were facilitated by members of the Implementation Science Team at Nova Scotia Health from November 2024 to January 2025. Focus group transcripts were coded deductively, and results were presented in a narrative and descriptive fashion.

Key findings highlight recurrent issues, including staff confusion over inclusion and exclusion criteria, inconsistent VUNS physician decision-making, workflow disruptions influenced by staffing shortages, and patient bounce-backs from the VUNS triage nurses or physician. While initial implementation demonstrated potential for reducing lower acuity patients' wait times and enhancing care delivery, operational challenges limited its effectiveness for some sites. Despite these barriers, success stories from specific sites emphasize the program's value, particularly in underserved rural areas. Recommendations for improvement focus on stabilizing criteria, enhancing staff training, optimizing workflows, and fostering consistent communication between stakeholders.

Findings indicate that VUNS should be scaled cautiously within current sites, addressing identified challenges before spreading to new locations. Lessons learned stress the importance of staff engagement, clear workflows, and patient education. These findings provide a roadmap for refining VUNS operations and contribute to the broader discourse on scaling digital healthcare innovations and streamlining patient flow in EDs.