Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study (Preprint)

Abstract

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.