New study shows equity-deserving populations feel Virtual Emergency Department (ED) promotes cultural safety

Embargoed for release until 2 p.m. ET June 4, 2024

During the COVID-19 pandemic ambulatory and outpatient care in Canada and beyond, shifted to a virtual setting for both non-urgent and urgent visits as means to avoid face-to-face contact whenever possible. Since then, the new modality of emergency care has remained sustainable for many practices and organizations including Sunnybrook.

While Virtual EDs faced common barriers to care, a new Sunnybrook-led study published in PLOS ONE has found that members from equity deserving populations (EDPs) preferred virtual emergency healthcare under certain circumstances as they found the Virtual ED to be a more socially and culturally safe space with improved access compared to their experiences of in-person ED care.

In this study, people from EDPs may include the Indigenous community, Black or other racialized communities of colour, women and gender diverse people, members of the 2SLGBTQI+ community, people with disabilities, recent immigrants or refugees, and people with low income.

“It has been documented that individuals from EDPs have experienced prejudice, discrimination and neglect while receiving care at in-person EDs,” explains Dr. Justin Hall, medical director of Sunnybrook’s Virtual ED and lead author of the study. “By avoiding stresses associated with in-person visits to the ED, like traveling and waiting in a busy waiting room with other patients and staff, members of EDPs felt more empowered accessing care through the Virtual ED.”

The study includes a total sample of 43 participants who were recent users of Sunnybrook’s Virtual ED and self-identified as a member of an EDP. Using thematic analysis, their experiences were interpreted by researchers, and from these results three main themes were identified: inequities experienced by EDPs when accessing in-person care, ways the Virtual ED promoted a safer care experience and opportunities to enhance Virtual ED care for EDPs.

Some participants noted how the remote nature of the Virtual ED promoted cultural safety and had positive effects on their mental health. Participants stated they felt less stressed and judged by not having to sit in a waiting room with other patients and interact with several staff members providing them a greater sense of control over their own health.

Overall, participants had positive reflections about their Virtual ED experience compared to in-person visits citing benefits like less travel and waiting time, and convenience and ease of the online booking tool. Additionally, common challenges including the inability to physically assess all patient concerns were identified as a disadvantage. Participants also expressed the need for targeted outreach to help raise awareness of the service to their community.

“The perspectives of EDPs play a crucial role in developing and enhancing care programs like the Virtual ED,” says Dr. Sander Hitzig, director of the St. John’s Rehab Research Program at Sunnybrook Research Institute and co-author of the study. “This research will inform how a culturally-safe experience can be maintained and strengthened in virtual modes of care.”