Virtual First Uses Virtual Emergency Medicine Clinicians as a Health System Entry Point: A Cross-Sectional Survey Study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic accelerated utilization and acceptance of telemedicine. Simultaneously, Emergency Departments (ED) have experienced significantly increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding we proposed an 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 utilizing 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 seek care for acute care needs. METHODS: VF is a synchronous virtual video visit stationed at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints, or if necessary, referral to a primary care physician (PCP), urgent care center (UCC), or 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. This is a cross- sectional survey study. 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 of 3097 (5.7%) completed the survey. 87 of 176 (49.4%) would have sought care at UCCs if VF had not been available. Twenty-eight (15.9%), twenty-six (14.8%), and one (0.6%) would have sought care at PCPs, EDs, or other locations, respectively. Interestingly, 34 of 176 (19.3%) of patients would not have sought care. The most valued aspects of VF were receiving care in the comfort of home (137 of 176; 77.8%), availability of appointments (105 of 176; 59.6%), not waiting in a lobby (100 of 176; 56.8%), and decreased infectious exposure (89 of 176; 50.6%). For suggested improvements to VF, 58 of 176 (33.0%) patients free-texted "Nothing", 47 (26.7%) suggested connectivity improvements, 23 (13.1%) wanted the ability to have lab work or imaging ordered, 14 (8.0%) had to seek medical care after the VF visit , and desired having a doctor perform a physical exam (5.7%). CONCLUSIONS: VF has potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% 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 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.

The unequal impact of Covid-19 on the lives and rights of the children of modern slavery survivors, children in exploitation and children at risk of entering exploitation.

This article discusses the unequal impact of Covid-19 on the lives of the children of survivors of modern slavery, child victims of exploitation and children at risk of exploitation in the UK. It draws on research that has analysed the risks and impacts of Covid-19 on victims and survivors of modern slavery. It explores how pandemic responses may have hindered these children's rights to education, food, safety, development and participation and representation in legal processes. It suggests that the pandemic should be used as an impetus to address inequalities that existed pre-Covid-19 and those that have been exacerbated by it.