Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative

Abstract

BackgroundThe COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time.Local problemThe Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH.MethodsThe COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles.ResultsFollowing the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected.ConclusionsThis report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19.RegistrationThis project was submitted to the RNOH’s Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).

Rapid implementation and improvement of a virtual student placement model in response to the COVID-19 pandemic

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Pain management programmes via video conferencing: a rapid review

“…Staff training on the safe use of tele-health technology in important including identifying suitable candidates and conducting risk assessments [4,[15][16][17].…”

“…High levels of anxiety have been reported amongst clinicians regarding the rapid switch to online service delivery [6]. Some issues clinicians have experienced include not being familiar with software, concerns about effectiveness, and adapting style to online delivery are [4]. No published data related to the role of clinician confidence with VC on outcomes for PMPs exists at present.…”

“…Pain services have moved to rapidly implement telehealth solutions, largely via telephone, and increasingly using Video Conferencing (VC), predominantly for one-toone or multidisciplinary assessments [3,4]. Relaxation of regulatory frameworks around information governance [5], and increased software availability, has facilitated rapid implementation.…”

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“…The existing infrastructure has made it easier for these institutions to adapt their teaching by having medical students attend MDTs virtually. The same principle of an adaptable infrastructure can be applied to the role of virtual clinics [ 11 , 12 ] in medical education. History-taking skills can be practiced with simulated patients or even real patients, as more health care providers begin to use video and phone consultations.…”