Saving emergency medicine: is less more?

Atkinson, Paul; McGeorge, Ken; Innes, Grant

doi:10.1007/s43678-021-00237-1

Cited by 33 publications

(17 citation statements)

References 4 publications

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“…While it seems virtual care will be one of the enduring modernizations that survives the pandemic, it remains unclear which type of healthcare practitioner is best suited to provide this service. Considering the low acuity of presenting complaints, one might question if virtual care is a service emergency physicians and nurses should be providing in the context of severe ED workforce shortages [ 17 – 20 ]. Future directions in the provision of virtual care should consider if nurse practitioners, physician assistants and primary care physicians could be integrated in virtual urgent care as part of a “primary care first” strategy, with the opportunity to escalate to a virtual ED physician prior to recommending an in-person ED visit.…”

Section: Discussionmentioning

confidence: 99%

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

et al. 2022

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Introduction As part of the COVID-19 pandemic response, the Ontario Ministry of Health funded a virtual care pilot program intended to support emergency department (ED) diversion of patients with low acuity complaints and reduce the need for face-to-face contact. The objective was to describe the demographic characteristics, outcomes and experience of patients using the provincial pilot program. Methods This was a prospective cohort study of patients using virtual care services provided by 14 ED-led pilot sites from December 2020 to September 2021. Patients who completed a virtual visit were invited by email to complete a standardized, 25-item online survey, which included questions related to satisfaction and patient-reported outcome measures. Results There were 22,278 virtual visits. When patients were asked why they contacted virtual urgent care, of the 82.7% patients who had a primary care provider, 31.0% said they could not make a timely appointment with their family physician. Rash, fever, abdominal pain, and COVID-19 vaccine queries represented 30% of the presenting complaints. Of 19,613 patients with a known disposition, 12,910 (65.8%) were discharged home and 3,179 (16.2%) were referred to the ED. Of the 2,177 survey responses, 94% rated their overall experience as 8/10 or greater. More than 80% said they had answers to all the questions they had related to their health concern, believed they were able to manage the issue, had a plan they could follow, and knew what to do if the issue got worse or came back. Conclusions Many presenting complaints were low acuity, and most patients had a primary care provider, but timely access was not available. Future work should focus on health equity to ensure virtual care is accessible to underserved populations. We question if virtual urgent care can be safely and more economically provided by non-emergency physicians. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00407-9.

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Section: Discussionmentioning

confidence: 99%

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

et al. 2022

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“…A recent Canadian Journal of Emergency Medicine editorial by Atkinson et al outlined systems-based challenges threatening the current paradigm of EM including disproportionately high usage, lack of access to primary care, access block, and lack of long-term care funding [18]. The searing commentary resonated with emergency physicians across the country, as evidenced by robust online discussion and the second highest Altmetric Attention Score of all time for any CJEM article [19].…”

Section: Comparison To Previous Studiesmentioning

confidence: 99%

COVID-19 has heightened tensions between and exposed threats to core values of emergency medicine

et al. 2022

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Background Professional culture is a powerful influence in emergency departments, but incompletely understood. Disasters magnify cultural realities, and as such the COVID-19 pandemic offered a unique opportunity to better understand emergency medicine (EM) values, practices, and beliefs. Methods We conducted a collaborative ethnography at a tertiary care center during the acute phase of the response to the threat of COVID-19 (March–May 2020). Collaborative ethnography is a method that partners directly with communities during design, data gathering, and analysis to study culture. An ED-based research team gathered data including field notes from 300 h of participant observation and informal interviews, 42 semi-structured interviews, and 57 departmental documents. Data were deductively coded using a previously generated framework for understanding EM culture. Results Each of seven core values from the original framework were identified in the dataset and further contextualized understanding of EM culture. COVID-19 exacerbated pre-existing tensions and threats to the core values of EM. For example, the desire to provide patient-centered care was impeded by strict visitor restrictions; the ability to treat life-threatening illness was impaired by new resuscitation room layouts and infection control procedures; and subtle changes in protocols had downstream impact on flow and the ability to balance needs and resources at a system level. The cultural values related to teams were protective and strengthened during this time. The pandemic exposed problems with the status quo, underscored inherent tensions between ED values, and highlighted threats to self-identity. Conclusion COVID-19 has highlighted and compounded existing tensions and threats to the core values of EM, underscoring a critical mismatch between values and practice. Realignment of the realities of ED work with staff values is urgently needed.

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“…Thus, many of the problems in today's emergency medicine may be at the root of this situation that is appearing all over the Western world where students are turning their backs on our specialty, where the expected succession of emergency physicians over the next decade is fading away in favor of organ overspecialization, where among our troops, burnouts, requests for part-time work or changes in specialty are increasing. This is logical, and it is not sure that it is possible to reverse the trend in the current context [10]. Therefore, will we see an evolution towards an overspecialization of "recuscitationists" versus hospital-based primary care practitioners, even though in our incredibly diverse specialty, most countries in Europe are moving towards emergency medicine specialists who practice in the same way?…”

mentioning

confidence: 99%

Impact of the pandemic on emergency medicine and its future

Peschanski

2022

European Journal of Emergency Medicine

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Saving emergency medicine: is less more?

Cited by 33 publications

References 4 publications

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

COVID-19 has heightened tensions between and exposed threats to core values of emergency medicine

Impact of the pandemic on emergency medicine and its future

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