Qualitative analysis of values and motivation reported by families utilizing a paediatric virtual care emergency clinic launched during the SARS-CoV-2 pandemic.

PURPOSE: This is the first study to take an in-depth qualitative approach to identify motivating factors for caregivers who chose the paediatric emergency virtual care option in Canada during the SARS-CoV-2 pandemic. The role that virtual care may play moving forward is also considered. METHODS: Between May 2020 and May 2021, 773 respondents attending the virtual clinic completed a follow-up survey with open-ended questions. For qualitative content analysis, comments were coded and analysed until thematic saturation was reached. Sub-codes were subsumed into major coding categories to identify themes. RESULTS: Three major themes, including safety, reassurance and convenience, and an overarching theme of satisfaction emerged from this analysis. Paediatric virtual clinic use was motivated in part by a desire to avoid the hospital environment. In-person Emergency Department visits were reported to be challenging and stressful, particularly due to perceived infection risk. Respondents appreciated that the clinic provided reassurance by assisting in navigating the healthcare system during a time of uncertainty and felt the virtual option allowed them to use healthcare resources responsibly. The convenience and ease of access to virtual care allowed for improved family-centred care in vulnerable populations. The overarching theme of satisfaction was emphasized by numerous comments for this service to be offered post-pandemic. CONCLUSION: Our study indicates that virtual care was an attractive option for caregivers due to the safety, reassurance, and convenience provided. The strong patient desire for continued availability post-pandemic will be important considerations in this rapidly developing area of care.

RéSUMé: OBJECTIF: Il s'agit de la première étude à adopter une approche qualitative approfondie pour identifier les facteurs de motivation des aidants qui ont choisi l'option des soins virtuels d'urgence pédiatrique au Canada pendant la pandémie de SRAS-CoV-2. Le rôle que les soins virtuels pourraient jouer à l'avenir est également envisagé. MéTHODES: Entre mai 2020 et mai 2021, 773 personnes ayant participé à la clinique virtuelle ont répondu à une enquête de suivi comportant des questions ouvertes. Pour l'analyse qualitative du contenu, les commentaires ont été codés et analysés jusqu'à ce que la saturation thématique soit atteinte. Les sous-codes ont été subsumés en grandes catégories de codage afin d'identifier les thèmes. RéSULTATS: Trois thèmes principaux, à savoir la sécurité, le réconfort et la commodité, ainsi qu'un thème général de satisfaction ont émergé de cette analyse. L'utilisation de la clinique virtuelle pédiatrique a été motivée en partie par le désir d'éviter l'environnement hospitalier. Les visites en personne dans les services d'urgence ont été jugées difficiles et stressantes, notamment en raison du risque d'infection perçu. Les personnes interrogées ont apprécié que la clinique les rassure en les aidant à s'orienter dans le système de santé pendant une période d'incertitude et ont estimé que l'option virtuelle leur permettait d'utiliser les ressources de santé de manière responsable. La commodité et la facilité d'accès aux soins virtuels ont permis d'améliorer les soins centrés sur la famille dans les populations vulnérables. Le thème général de la satisfaction a été souligné par de nombreux commentaires pour que ce service soit offert après la pandémie. CONCLUSION: Notre étude indique que les soins virtuels sont une option attrayante pour les aidants en raison de la sécurité, du réconfort et de la commodité qu'ils procurent. Le désir profond des patients de continuer à bénéficier de ces services après la pandémie sera un élément important à prendre en compte dans ce domaine de soins qui se développe rapidement.

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

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.

RéSUMé: INTRODUCTION: Dans le cadre de la réponse à la pandémie de COVID-19, le ministère de la Santé de l'Ontario a financé un programme pilote de soins virtuels visant à soutenir la réorientation vers les services d'urgence des patients présentant des problèmes de faible acuité et à réduire le besoin de contact en personne. L'objectif était de décrire les caractéristiques démographiques, les résultats et l'expérience des patients utilisant le programme pilote provincial. MéTHODES: Il s'agissait d'une étude de cohorte prospective de patients utilisant des services de soins virtuels fournis par 14 sites pilotes dirigés par des services d'urgence, de décembre 2020 à septembre 2021. Les patients qui ont effectué une visite virtuelle ont été invités par courriel à répondre à une enquête en ligne standardisée de 25 questions, qui comprenait des questions relatives à la satisfaction et aux résultats rapportés par les patients. RéSULTATS: Il y a eu 22 278 visites virtuelles. Lorsqu'on a demandé aux patients pourquoi ils avaient contacté les soins urgents virtuels, sur les 82,7 % de patients qui avaient un prestataire de soins primaires, 31,0 % ont répondu qu'ils n'avaient pas pu obtenir un rendez-vous en temps voulu avec leur médecin de famille. Les éruptions cutanées, la fièvre, les douleurs abdominales et les interrogations sur le vaccin COVID-19 représentaient 30 % des plaintes présentées. Sur les 19 613 patients dont la disposition était connue, 12 910 (65,8 %) ont été renvoyés chez eux et 3 179 (16,2 %) ont été orientés vers les urgences. Sur les 2 177 réponses à l'enquête, 94 % ont attribué une note de 8/10 ou plus à leur expérience globale. Plus de 80 % d'entre eux ont déclaré avoir obtenu des réponses à toutes les questions qu'ils se posaient sur leur problème de santé, se croire capables de le gérer, avoir un plan qu'ils pouvaient suivre et savoir quoi faire si le problème s'aggravait ou revenait. CONCLUSIONS: De nombreuses plaintes présentées étaient de faible acuité, et la plupart des patients avaient un fournisseur de soins primaires, mais l'accès en temps opportun n'était pas disponible. Les travaux futurs devraient se concentrer sur l'équité en matière de santé pour s'assurer que les soins virtuels sont accessibles aux populations mal desservies et nous nous demandons si ces services peuvent être fournis en toute sécurité et de manière plus économique par des médecins non urgentistes.

Temporal trends in anaphylaxis ED visits over the last decade and the effect of COVID-19 pandemic on these trends.

BACKGROUND: Anaphylaxis is an acute systemic and potentially fatal allergic reaction. We evaluated trends in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. METHODS: A prospective and retrospective recruitment process was used to find families of children who had presented with anaphylaxis at the Montreal Children's Hospital between April 2011 and April 2021. Using a uniform recruitment form, data were collected. Anaphylaxis patterns were compared to clinical triggers using descriptive analysis. RESULTS: Among 830,382 ED visits during the study period, 2726 (26% recruited prospectively) presented with anaphylaxis. The median age was 6 years (IQR: 0.2, 12.00), and 58.7% were males. The relative frequency of anaphylaxis cases doubled between 2011-2015, from 0.22% (95% CI, 0.19, 0.26) to 0.42 March 2020, the total absolute number of anaphylaxis cases and relative frequency declined by 24 cases per month (p < 0.05) and by 0.5% of ED visits (p < 0.05). CONCLUSIONS: The rate of anaphylaxis has changed over the years, representing modifications in food introduction strategies or lifestyle changes. The decrease in the frequency of anaphylaxis presenting to the ED during the COVID pandemic may reflect decreased accidental exposures with reduced social gatherings, closed school, and reluctance to present to ED.

Designs, facilitators, barriers, and lessons learned during the implementation of emergency department led virtual urgent care programs in Ontario, Canada.

Introduction: Virtual patient care has seen incredible growth since the beginning of the COVID-19 pandemic. To provide greater access to safe and timely urgent care, in the fall of 2020, the Ministry of Health introduced a pilot program of 14 virtual urgent care (VUC) initiatives across the province of Ontario. The objective of this paper was to describe the overall design, facilitators, barriers, and lessons learned during the implementation of seven emergency department (ED) led VUC pilot programs in Ontario, Canada. Methods: We assembled an expert panel of 13 emergency medicine physicians and researchers with experience leading and implementing local VUC programs. Each VUC program lead was asked to describe their local pilot program, share common facilitators and barriers to adoption of VUC services, and summarize lessons learned for future VUC design and development. Results: Models of care interventions varied across VUC pilot programs related to triage, staffing, technology, and physician remuneration. Common facilitators included local champions to guide program delivery, provincial funding support, and multi-modal marketing and promotions. Common barriers included behaviour change strategies to support adoption of a new service, access to high-quality information technology to support new workflow models that consider privacy, risk, and legal perspectives, and standardized data collection which underpin overall objective impact assessments. Conclusions: These pilot programs were rapidly implemented to support safe access to care and ED diversion of patients with low acuity issues during the COVID-19 pandemic. The heterogeneity of program implementation respects local autonomy yet may present challenges for sustainability efforts and future funding considerations.

Emergency medicine physician burnout and wellness in Canada before COVID19: A national survey.

INTRODUCTION: Emergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19. OBJECTIVES: To describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic. METHODS: A modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory - Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide. RESULTS: A total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year. CONCLUSION: Canadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic.