Sustainability in Quality Improvement: Outcomes of a Novel Pediatric Virtual Urgent Care in Ontario, Canada

Introduction: Virtual care is expected to play an increasingly important role in the Canadian healthcare system, with the 2023-2024 Health Canada Departmental Plan outlining the advancement of digital health solutions as a focal point. However, key outcomes of transitioning from traditional in-person healthcare appointments to a virtual model of care are not yet well-described. Here, we apply the Sustainability in Quality Improvement (SusQI) framework to patients seen in a novel pediatric virtual urgent care (VUC) program to quantify the environmental, economic, and social impacts of virtual care.

Methods: We conducted a retrospective analysis of provincial pediatric VUC visits staffed by pediatric emergency physicians and nurse practitioners during the 2020-2025 fiscal years. We focused on three key metrics: (1) economic value, measured as travel costs avoided; (2) environmental value, measured in fuel saved (L) and carbon emissions reduced (kg CO₂ eq); and (3) social value, assessed using Ontario Marginalization (ON-Marg) Index quintiles.

Results: A total of 12,900 virtual visits were completed during the study period, 99.9% via the Webex platform. Net savings totaled $998,100. Environmental benefits included 128,700 L of fuel saved and 384,200 kg CO₂ eq emissions avoided. Summary ON-Marg Index scores were similar between groups (2.87 for in-person emergency department (ED) visits; 2.91 for virtual visits). Data collected between July 2023-April 2025 show that 10.6% (353) of visits resulted in subsequent in-person ED presentation.

Conclusion: Virtual urgent care resulted in significant financial and environmental savings per visit. These benefits included reduced financial and time burdens for families, lower hospital-related expenditures, improved environmental performance, and diversion of low-acuity cases from the ED. Comparable ON-Marg scores between patients seen virtually and in-person suggest accessibility across socioeconomic groups. These findings indicate that pediatric VUC is a viable complement to traditional care, providing meaningful cost and environmental savings while ensuring equitable access.