Background The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians’ (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective The goal of this study is to investigate how patients’ access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question “How would you have sought care if a VF visit was not available to you?” Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included “Nothing” as free text. Conclusions VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF’s innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits.
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic accelerated utilization and acceptance of telemedicine. With this acceptance, we proposed an innovative Virtual First (VF) program to leverage Emergency Medicine Providers’ (EMPs) ability to triage patients with acute illness. OBJECTIVE The goal of this study is to investigate how patients' access to EMPs from home via the establishment of VF changed how patients seek care for unplanned illness or injury. METHODS VF is a synchronous virtual video visit stationed at a tertiary care academic hospital. VF was staffed by EMPs and enabled full management of patient complaints, or if necessary, referral to a primary care physician (PCP), urgent care center (UCC), or Emergency Department (ED). Patients self-selected this service as an alternative to seeking in-person care at PCP, UCC or ED. A post-visit convenience sample survey was collected through phone text message or email to VF users. Primary outcome measure is based on responses to the question, “How would you have sought care if a VF visit was not available to you?” Secondary outcome measures describe valued aspects and criticisms from their visit. Results were analyzed using descriptive statistics. RESULTS There were 3097 patients seen via VF from July 2021 through May 2022. 176 (5.7%) completed the survey. Many patients would have sought care at UCCs (49.4%) if VF had not been available. 15.9%, 14.8%, 0.6% would have sought care at PCPs, EDs, or other locations, respectively. 19.3% of patients would not have sought care. The most valued aspects of VF were receiving care in the comfort of home (77.8%), availability of appointments (59.6%), not waiting in a lobby (56.8%), and decreased infectious exposure (50.6%). For suggested improvements to VF, patients free-texted “Nothing” (33.0%), suggested connectivity improvements (26.7%), wanted the ability to have lab work or imaging ordered (13.1%), having to seek medical care after the VF visit (8.0%), and desired having a doctor perform a physical exam (5.7%). CONCLUSIONS VF has potential to restructure how patients seek medical care by connecting EMPs with patients prior to ED arrival. Without the option of VF, 64.2% of patients would have sought care at an acute care facility. Future studies are needed to evaluate the efficacy of VF to divert unnecessary visits from acute care facilities.
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