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Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory

BACKGROUND: COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care’s potential role remains unclear in the urgent care setting. In December 2020, the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health...

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Autores principales: Shuldiner, Jennifer, Srinivasan, Diya, Hall, Justin N, May, Carl R, Desveaux, Laura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513685/
https://www.ncbi.nlm.nih.gov/pubmed/36094801
http://dx.doi.org/10.2196/39430
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author Shuldiner, Jennifer
Srinivasan, Diya
Hall, Justin N
May, Carl R
Desveaux, Laura
author_facet Shuldiner, Jennifer
Srinivasan, Diya
Hall, Justin N
May, Carl R
Desveaux, Laura
author_sort Shuldiner, Jennifer
collection PubMed
description BACKGROUND: COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care’s potential role remains unclear in the urgent care setting. In December 2020, the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health Sciences Centre by connecting patients to emergency physicians through an online portal. OBJECTIVE: This study aims to understand whether and how ED physicians were able to integrate a virtual ED alongside in-person operations. METHODS: We conducted semistructured interviews with ED physicians guided by the Normalization Process Theory (NPT). The NPT provides a framework to understand how individuals and teams navigate the process of embedding new models of care as part of normal practice. All physicians who had worked within the virtual ED model were invited to participate. Data were analyzed using a combination of inductive and deductive techniques informed by the NPT. RESULTS: A total of 14 physicians were interviewed. Participant experiences were categorized into 1 of 2 groups: 1 group moved to normalize the virtual ED in practice, while the other described barriers to routine adoption. These groups differed in their perception of the patient benefits as well as the perceived role in the virtual ED. The group that normalized the virtual ED model saw value for patients (coherence) and was motivated by patient satisfaction witnessed (reflexive monitoring) at the end of the virtual appointment. By contrast, the other group did not find virtual ED work reflective of the perceived role of urgent care (cognitive participation) and felt their skills as ED physicians were underutilized. The limited ability to examine patients and a sense that patient issues were not fully resolved at the end of the virtual appointment caused frustration among the second group. CONCLUSIONS: As further digital integration within the health care system occurs, it will be essential to support the evolution of staff skill sets to ensure physicians are satisfied with the care they are providing to their patients, while also ensuring the technology and process are efficient.
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spelling pubmed-95136852022-09-28 Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory Shuldiner, Jennifer Srinivasan, Diya Hall, Justin N May, Carl R Desveaux, Laura JMIR Hum Factors Original Paper BACKGROUND: COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care’s potential role remains unclear in the urgent care setting. In December 2020, the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health Sciences Centre by connecting patients to emergency physicians through an online portal. OBJECTIVE: This study aims to understand whether and how ED physicians were able to integrate a virtual ED alongside in-person operations. METHODS: We conducted semistructured interviews with ED physicians guided by the Normalization Process Theory (NPT). The NPT provides a framework to understand how individuals and teams navigate the process of embedding new models of care as part of normal practice. All physicians who had worked within the virtual ED model were invited to participate. Data were analyzed using a combination of inductive and deductive techniques informed by the NPT. RESULTS: A total of 14 physicians were interviewed. Participant experiences were categorized into 1 of 2 groups: 1 group moved to normalize the virtual ED in practice, while the other described barriers to routine adoption. These groups differed in their perception of the patient benefits as well as the perceived role in the virtual ED. The group that normalized the virtual ED model saw value for patients (coherence) and was motivated by patient satisfaction witnessed (reflexive monitoring) at the end of the virtual appointment. By contrast, the other group did not find virtual ED work reflective of the perceived role of urgent care (cognitive participation) and felt their skills as ED physicians were underutilized. The limited ability to examine patients and a sense that patient issues were not fully resolved at the end of the virtual appointment caused frustration among the second group. CONCLUSIONS: As further digital integration within the health care system occurs, it will be essential to support the evolution of staff skill sets to ensure physicians are satisfied with the care they are providing to their patients, while also ensuring the technology and process are efficient. JMIR Publications 2022-09-12 /pmc/articles/PMC9513685/ /pubmed/36094801 http://dx.doi.org/10.2196/39430 Text en ©Jennifer Shuldiner, Diya Srinivasan, Justin N Hall, Carl R May, Laura Desveaux. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 12.09.2022. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on https://humanfactors.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Shuldiner, Jennifer
Srinivasan, Diya
Hall, Justin N
May, Carl R
Desveaux, Laura
Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory
title Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory
title_full Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory
title_fullStr Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory
title_full_unstemmed Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory
title_short Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory
title_sort implementing a virtual emergency department: qualitative study using the normalization process theory
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513685/
https://www.ncbi.nlm.nih.gov/pubmed/36094801
http://dx.doi.org/10.2196/39430
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