A qualitative study on the Virtual Emergency Department care experiences of equity-deserving populations (2024)

What is this research about?

This qualitative study examined the experiences of patients from equity-deserving populations (EDPs) who received care from a Virtual Emergency Department (ED) in Toronto, Canada. The researchers wanted to understand how virtual care compared to in-person care for EDPs and what aspects promoted or hindered equitable access and experiences.

Report abstract:

"Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQI+ community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing virtual models of care. The objective of this qualitative study was to describe the experiences of patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada. Forty-three participants (36 patients and 7 family caregivers) with different and intersecting identities who used the Virtual ED participated in the study. Semi-structured interviews were conducted to explore reasons for accessing the Virtual ED, barriers to access, and how the Virtual ED met their care needs and expectations, including ways their experience could have been improved. Thematic analysis was used to identify themes from the data. Patients from equity-deserving populations described negative past experiences with ED in-person care, which included recounts of discrimination or culturally insensitive care while waiting to see the ED physician or nurse. Conversely, participants found the Virtual ED to be a socially and culturally safe space since they could now by-pass the waiting room experience. However, virtual care could not replace in-person care for certain issues (e.g., physical exam), and there was a need for greater promotion of the service to specific communities that might benefit from having access to the Virtual ED. Targeted outreach to help raise awareness of the service to equity-deserving communities is an important future direction."

What do you need to know?

• EDPs include racialized communities, 2SLGBTQI+ individuals, refugees/immigrants, people with disabilities, and other underserved groups.
• Virtual EDs were established during the COVID-19 pandemic to minimize in-person contact.
• There are concerns about access and quality of care for EDPs using virtual models.

What did the researchers do?

• Conducted semi-structured interviews with 43 participants (36 patients, 7 family caregivers) from diverse EDPs who used the Virtual ED.
• Asked about reasons for accessing the Virtual ED, barriers, how it met care needs/expectations, and suggestions for improvement. Participants discussed their motivations for using the Virtual ED, barriers faced, and overall experiences with the service.
• The researchers conducted an inductive qualitative study using Codebook Thematic Analysis (TA). They analyzed the interview data using thematic analysis to identify key themes.

What did the researchers find?

Three main themes emerged:

1. The Virtual ED was perceived as a safer, more controlled environment that bypassed some triggering issues associated with in-person care. EDPs reported negative past experiences with in-person ED care, including discrimination and culturally insensitive treatment.
2. Challenges using the Virtual ED included language barriers, lack of awareness about the Virtual ED, and technological difficulties (e.g., needing a computer with internet and Zoom access)​
3. While the Virtual ED had benefits like convenience and flexibility, there were opportunities to enhance the service for EDPs, such as improving language support and technology accessibility. Participants suggested improvements like displaying pronouns, enhancing cultural sensitivity, and increasing awareness within EDP communities to make the Virtual ED more inclusive.

Participants described their experiences with the Virtual ED in several key ways:

1. Increased safety and control:

• Many participants felt the Virtual ED provided a "safer" and more controlled environment compared to in-person ED visits.
• They appreciated being able to bypass the waiting room experience, which was often associated with negative interactions in the past. Participants felt more in control of their care, with one noting "I felt safer doing it virtually than I would going in, especially with my mental health".

2. Improved accessibility and convenience:

• Participants highlighted the ease, convenience and flexibility of the Virtual ED, including the online booking system.
• They appreciated not having to travel to the ED or wait for long periods to see a physician. Some noted it allowed them to have family members present during the appointment, which was not always possible with in-person visits due to COVID-19 restrictions.

3. More equitable and culturally sensitive care:

• Many participants felt they received more respectful and validating care through the Virtual ED compared to past in-person experiences.
• One participant noted: "They did not cut me off when I was speaking. They did not say that I was incorrect for how I was feeling, so I was not invalidated in any way."

4. Some limitations of virtual care:

• Participants recognized that virtual care could not fully replace in-person care for all issues, particularly those requiring physical examinations.
• Some experienced technical challenges, especially if using smaller devices like smartphones instead of computers.

5. Suggestions for improvement:

• Participants recommended increasing language support for non-English speakers.
• They suggested displaying staff pronouns and using inclusive imagery to create a more welcoming environment for LGBTQ+ patients. Many emphasized the need for greater promotion of the Virtual ED service, particularly to specific equity-deserving communities

How can you use this research?

• Recognize the potential of virtual care to provide a safer, more equitable experience for EDPs.
• Provide assistance for those who may struggle with the technological requirements of virtual care, such as help lines or step-by-step guides.
• Enhance virtual platforms to be more inclusive and accessible (e.g., multiple languages, accommodations for disabilities).
• Provide cultural competency training for all staff interacting with patients. Implement multilingual support and ensure that information about the Virtual ED is widely disseminated within EDP communities. Consider displaying staff pronouns and using inclusive imagery in virtual care settings.
• Develop partnerships with community organizations serving EDPs to improve service delivery and awareness. Implement targeted outreach to raise awareness of Virtual ED services among EDP communities, particularly in communities that might face discrimination in traditional ED settings.