Virtually speaking: 3 docs on how virtual ER programs have affected their lives
Virtual emergency care has been popping up at hospitals across Canada in an effort to prevent unnecessary ER visits help patients who may be hesitant or unable to visit in person.
So, what it’s like for the doctors staffing the virtual ER? We spoke with three such physicians.
Dr. Sheena Belisle, The Children’s Hospital, London Health Sciences Centre
The Children’s Hospital opened its virtual urgent care clinic in May 2020. It operates daily from 3:00 p.m. to 7:00 p.m. It’s seen more than 6,000 patients so far, who access the clinic through secure video chat by calling a toll-free number or booking an appointment online.
“The goal of our pediatric emergency medicine physicians is to assist families in deciding if medical attention is needed, and if so, the best setting to receive the care,” Dr. Belisle says. “The children are sometimes directed to their closest emergency department or may be asked to make an appointment with their family doctor or pediatrician.”
Doctors also sometimes manage the concern virtually and can send patient notes electronically to primary care providers.
Dr. Belisle says physicians usually work virtual shifts from home, taking them on a voluntary basis. Some do one a month, while others take five or more. “The shifts are in addition to our in-person shifts. The benefit to our physicians is the convenience of working from home. We also get high satisfaction from helping families decide the best route of care for their child, as families are extremely satisfied and grateful for our services.”
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“Our biggest challenge is manpower. The demands within our physical department are at an all-time high. We are attempting to fill additional shifts to manage our in-person volumes. It is often difficult to also manage filling our virtual shifts. Our physicians routinely overextend themselves in effort to serve our community because we truly believe we are making a difference.”
Dr. Belisle believes the pediatric virtual urgent care clinic is here to stay. While most patients are from London and surrounding area, families from remote Northern Ontario also use the service. She hopes to collaborate with other pediatric emergency medicine centres to support families in communities without easy access to care.
“Making decisions about the need to seek medical attention can be much more difficult for families in remote locations. They have many more factors to consider than our urban families, for example weather and distance to care. We are likely to have the biggest impact on these families and hope we can make our services even more readily available to them in the future.”
Dr. Shaun Mehta, an emergency physician at St. Michael’s Hospital and the co-lead of Toronto’s Virtual Emergency Department, a partnership between Unity Health, Sunnybrook Health Sciences Centre and University Health Network.
The virtual ER operates 9:00 a.m. to 9:00 p.m. on weekdays and 9:00 a.m. to 1:00 p.m. weekends, with physicians from each hospital site rotating coverage and seeing patients from all hospitals. The physician and clerical staff member can work from an on-site workspace or from home.
The clerical staff are trained to understand the nature of patients’ concerns and advise them when to go to the in-person emergency room. When they are unsure, they consult the doctor.
Physicians work virtual ER shifts voluntarily in addition to their regular shifts. Dr. Mehta says he does about one to three a month.
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While statistics aren’t available on whether the virtual ER has reduced ER visits or wait times, Dr. Mehta says each patient receives a survey about their experience. One of the survey questions asks whether would have come to the ER in person if the virtual ER did not exist.
“More than half of patients said that they would have,” Dr. Mehta said. “There are also definitely patients who would have not sought care at an emergency department who connect with a virtual emergency department. And these are patients who don't have a family doctor or whose physician is not accessible at that time.”
About 25% of patients ultimately get sent to the emergency department. “Then I can call my colleague in the department and tell them I am sending a patient in, and we can get the ball rolling a little bit quicker,” he says. “It doesn't mean their length of stay is going to be shorter necessarily, but I can make the life of my colleagues easier because a partial assessment has been completed. So that's been a helpful workflow for us.”
In the instances where they can tell patients to see their family doctor or order them a blood test, Dr. Mehta says the virtual ER saves patients time.
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Dr. Janet Sommers, chief of the emergency department at Colchester East Hants Health Centre.
VirtualEmergencyNS launched in February 2022— a different spin on the virtual ER, where off-site physicians virtually see patients who are at the in-person ER.
In March 2020, the hospital acquired two iPads and a digital stethoscope and Zoom licenses for a different purpose. “I could foresee difficulties in providing continuous coverage if a number of physicians became sick,” Dr. Sommers said. “I was aiming to protect my physician human resource, to be able to provide care to the community and to keep my colleagues safe while examining patients on respiratory precautions from outside the room.
“It didn't take long before I realized the technology could help us with some of the other challenges we were facing. For example, if a doctor became sick with COVID, they could still provide care, which I actually did. When I developed COVID, I was able to run some virtual clinics.”
Physicians perform virtual ER shifts as part of their regular rotation. Dr. Sommers says it’s helpful in situations like if a physician breaks their ankle, is easing back into work after maternity leave or wants to work from their cottage.
“It allows a doctor to continue to earn some income if they're unable to physically be in the emergency department. It is also an interesting experience. If you've been working in medicine for any length of time, variety is crucial to keeping yourself interested and engaged and this is a unique way to deliver emergency care. You are in your own home. It's quiet. You might have an opportunity to look things up or send information digitally to patients.”
All patients visiting the ER are triaged and put into the same pool. If a patient has consented to virtual care and their turn comes up in the virtual stream first, they’re seen virtually. A clinical assistant, who may be a nurse or paramedic, assists with a digital otoscope, a camera that allows the physician to look in throats and at skin and a digital stethoscope that streams heart sounds. The assistant performs needed exams, such as abdominal or neurological.
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Dr. Sommers says one challenge is buy-in from the community and colleagues regarding how useful or safe the service is. She says they’re aiming to answer these questions during this pilot phase, by early next year. “Many of the patients I see are elated with the experience. I think there's skepticism initially but then they feel they've gotten good care and it's usually much quicker than it would be if they had waited for the in-person stream.
“I had a day last week where I was able to see 12 patients in four hours. So, for the clinicians in the department, when you've got 30 people in your waiting room, having 12 fewer patients is definitely a win and that takes the pressure off.”
Dr. Sommers also believes the technology could help rural areas. “I think there's an application for this technology in more critically ill patients if you have the space and the nursing staff. So, I am hoping this will improve access to care for patients in rural places that have struggled to t have physician coverage.