Virtual urgent care clinic helps direct the right care to the right place

Virtual care has exploded in usage and scope since the beginning of the pandemic. In January 2021, Lakeridge Health launched an emergency department virtual care clinic to better direct patients coming into the ED. After registering online, patients would be assessed, triaged and advised to either proceed to the emergency department for an in-person visit or informed their care could be provided virtually. At that time, however, only a few large clinics had been incorporated into the ED virtual care pilot; the larger primary care community in Durham Region was not included.

That is, until Dr. Lubna Tirmizi got involved.

Working with the Local Health Integration Networks, Dr. Tirmizi, one of the primary care leads for the Durham Ontario Health Team, knew there was a need for collaboration. She played a key role in leading the expansion of Lakeridge Health’s ED virtual care pilot to include all primary care models in the first-ever community/acute-care virtual urgent care clinic (VUCC) in Ontario.

This one-of-a-kind model triages patients either to an in-person emergency department or to their primary care provider in the community. Once the visit is assigned to a patient-chosen primary care provider, the clinic or clinician receives a notification by email or SMS through an automated triage system. This model directs the patient to the right care at the right place, eliminating unnecessary visits and bottlenecks in the emergency department.

“Keeping the right care at the right place is what this is all about,” said Dr. Tirmizi. If a patient needs an ED visit, they are prioritized. Otherwise, the patient is triaged to the more appropriate place to get care – in the community.

Not only will this new model improve patients’ access to care, it is also proving to be good for doctors too. “I think the essence of what’s important is primary care collaboration with acute care provided at Lakeridge Health,” Dr. Tirmizi said.

The VUCC model is gaining attention from other ministries and health-care centres for being a cost-effective, sustainable, and scalable way to help divert urgent-care visits from the emergency department into the right community primary care partners, when appropriate, while promoting continuity of care. Other hospitals in the area — as well as some from outside the province, including Alberta Health Services — have reached out to Dr. Tirmizi to learn more about the VUCC model. The Ontario Ministry of Health is also supportive of the model and has designated billing codes for it.

Wrap-around care, connectivity can help ease burden on EDs

One of the goals of this pilot is connectivity. Any time community care is needed, the patient has access to a range of support services available in their community. This wrap-around care may eliminate unnecessary visits to the ED if other providers close to the patient’s home can manage appropriate care.

Consider these examples of how the VUCC can help direct wrap-around care, ease the burden on emergency department and better support patients in the community:

• A patient with no fixed address who has not renewed their health card goes to the emergency department for insulin care. In addition to being treated in the ED, the health-care team will address the patient’s socioeconomic determinants and register the patient’s medical history in a digital record so that the next time that patient needs insulin, they receive care in their community instead of making an unnecessary visit to the ED.
• A patient with flu-like symptoms who is triaged can avoid an ED visit by getting either a virtual appointment with their primary care provider or an in-person appointment in a local clinic. This allows the patient easy access to health care from their home and avoids exposing other patients to those suffering from an infectious illness.

Digital integration changes everything

“Language, dementia and other barriers often prevent patients from telling their story, which has been challenging when trying to connect the dots on a patient’s history regarding something as simple as the medications they take,” said Dr. Tirmizi.

But the virtual urgent care clinic can help with this, as it eliminates the need for patients to repeat their medical histories at different access points in the system. The patient’s history is entered into a standardized intake questionnaire, which is converted into a digital record and registered with other digital solutions for community physicians to access. There is total collaboration between Durham Region’s health-care teams, ensuring anyone providing care to a patient has access to the same information.

Patients receptive to VUCC model

Patient feedback on the virtual urgent care clinic has been very positive. One of the biggest impacts has been on patients with mobility or accessibility issues – those who may find it difficult to make in-person visits. Non-urgent health-care issues can be effectively managed over the phone, thereby offering these patients quality and continuous care from the safety and comfort of their homes. For those patients needing an in-person clinical visit, the process is efficient with potentially shorter wait times.

The VUCC can also provide a path forward for patients with social and/or economic factors that bring them to the emergency department for care. Dr. Tirmizi points to a story about a patient who was referred to the VUCC through a community homeless hub affiliated with Durham’s OHT as an example. The patient was suffering from a wound infection from an intravenous drug site and had several virtual visits with emergency care clinics. Through the VUCC intake, the patient was directed to the emergency department for in-person care and treated for sepsis. He received antibiotics, was vaccinated against COVID-19 and received other support services. Since then, he has successfully found housing by way of the wrap-around care offered in his community.

Seniors can also stand to benefit from the virtual urgent care clinic model, says Dr. Tirmizi.

“We also see a lot of isolated seniors,” she explained. “They get a mild infection. Their first and last call is to EMS, and they end up in emergency. If they were connected to the VUCC by self, family, pharmacist or personal support worker, we could treat them early on and prevent the emergency hospital visits. We see this situation at least twice a week.”