Real-Time Virtual Support as an Emergency Department Strategy for Rural, Remote, and Indigenous Communities in British Columbia: Descriptive Case Study.

"Conflicts of Interest: BB and JB received professional fees from the Rural Coordination Centre of British Columbia (RCCbc) or Northern Health Authority for work performed as Rural Urgent Doctor in-aid (RUDi) physicians. KH received grant funding from the British Columbia Ministry of Health and RCCbc to carry out the evaluation of the real-time virtual support initiative, with RUDi being 1 pathway. The authors have no other potential conflicts of interest to disclose."

"This work is part of the real-time virtual support (RTVS) evaluation, which is primarily funded by the British Columbia Ministry of Health and the Joint Standing Committee on Rural Issues. The authors thank the British Columbia Ministry of Health Primary Care Branch for support of the initiative. We would like to thank Ron Chapman, Becky Temple, Magda Duplessis, Ted Patterson, Matt Petrie, and Alan Ruddiman who championed the initiative in their respective roles. We would like to thank Sonya Cressman and Nelly Oelke for their critical review and feedback on the manuscript. A huge thank you to the community providers, Rural Urgent Doctor in-aid (RUDi) physicians, administrators, and IT team members who participated in interviews and for sharing their experiences and insights. Another issue related to sustainability was the need for extensive IT support both in starting up and implementing the strategy. Individuals involved “stepped up” and worked “above and beyond” for a shared goal. This included such acts as driving for 2 hours after the end of the workday to hook up equipment and navigating bureaucracy to obtain permissions for virtual physicians to access local systems. While a crisis necessitated this extraordinary effort, it is not sustainable for volunteerism to bolster efficiency. Funding and personnel for IT need to be in place to support the people within the virtual strategy."