背景:不列颠哥伦比亚省有200多个农村地区,远程,以及由于医生隔离而导致医疗保健资源有限的土著社区,临床资源稀疏,缺乏大学的支持,和提供者倦怠。实时虚拟支持(RTVS)点对点路径为患者和提供者提供支持。在COVID-19大流行加剧了现有的医疗保健差距和公平获得及时护理的情况下,RTVS提供了在农村社区的医院或患者家庭环境中部署的便携式和额外的机会。我们重点介绍了RTVS中农村紧急医生援助(RUDI)途径的故事,该途径在2021年成功支持了道森溪地区医院(DCDH)急诊科(ED)。
目的:本研究旨在描述快速实施过程,并确定成功实施的促进者和障碍。
方法:本案例研究以卫生系统学习的四重目标和社会责任框架为基础。整个研究期约为6个月。实施1周后,我们采访了RUDI医生,DCDH工作人员,卫生当局领导,和RTVS工作人员收集他们的经验。内容分析用于确定访谈中出现的主题。
结果:RUDI医生覆盖了39个通宵轮班,是245名接受DCDHED的患者中最负责任的提供者(MRP)。总共17次采访主要线人,揭示了与领导和关系有关的重要主题,作为报道成功的促进者,远程医生支持的经验,提供一个“安全网”,“寻找跨专业合作的新方式,以及整个过程中需要广泛的IT支持。质量改进结果确定了障碍,并就如何在未来案例中改进这种支持模式提出了切实的建议。
结论:通过在隔夜ED轮班期间充当MRP,RUDI阻止了DCDHED的关闭以及将患者转移到另一家农村医院。可以利用RTVS和农村ED之间现有的伙伴关系和相互信任来快速开发和实施数字健康解决方案,以缓解医生短缺的压力。特别是在COVID-19期间。通过建立新的和修改的临床工作流程,RTVS为受到倦怠挑战的农村患者和提供者提供了安全网。本案例研究提供了要实施的知识,以服务于未来的农村,远程,和处于危机中的土著社区。
British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021.
This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation.
This
case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews.
RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage\'s success, the experience of remote physician support, providing a \"safety net,\" finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases.
By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This
case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis.