Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative
Open accessAbstract
Background: The 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 problem: The 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. Methods: The 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. Results: Following 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. Conclusions: This 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. Registration: This project was submitted to the RNOH’s Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some issues clinicians have experienced include not being familiar with software, concerns about effectiveness, and adapting style to online delivery.
“Some issues clinicians have experienced include not being familiar with software, concerns about effectiveness, and adapting style to online delivery are [4].”
From Pain management programmes via video conferencing: a rapid review (2021) · cites this paper as [4]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8775 · Cited by 2,887 · cited 1× · see citing works
“Further research at the RNOH into preferences will likely sustain a legacy of clinically appropriate and acceptable VCs. Greenhalgh et al17 found that videoconferencing consultations appeared to work better when the patient and clinician knew each other.”
BackgroundThe Improvement Guide: A Practical Approach to Enhancing Organizational Performance
(1997) · Quality Management Journal · doi:10.1080/10686967.1998.11919154 · Cited by 2,876 · see citing works
Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory
May, C., & Finch, T. (2009) · Sociology · doi:10.1177/0038038509103208 · Cited by 2,115 · see citing works
Alderwick, H., & Dixon, J. (2019) · British medical journal · doi:10.1136/bmj.l84 · Cited by 1,985 · see citing works
Coronavirus disease 2019: What we know?
He, F., Deng, Y., & Li, W. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25766 · Cited by 1,026 · see citing works
Implementation, context and complexity
May, C. R., Johnson, M., & Finch, T. (2016) · Implementation Science · doi:10.1186/s13012-016-0506-3 · Cited by 978 · see citing works
The improvement guide : a practical approach to enhancing organizational performance
Langley, G. J. (1996) · Jossey-Bass Publishers eBooks · Cited by 884 · see citing works
Video consultations for covid-19
Greenhalgh, T., Wherton, J., Shaw, S., & Morrison, C. (2020) · BMJ · doi:10.1136/bmj.m998 · Cited by 866 · see citing works
Covid-19: a remote assessment in primary care
Greenhalgh, T., Koh, G. C. H., & Car, J. (2020) · BMJ · doi:10.1136/bmj.m1182 · Cited by 705 · see citing works
Greenhalgh, T., Shaw, S., Wherton, J., Vijayaraghavan, S., Morris, J., Bhattacharya, S., Hanson, P., Campbell-Richards, D., Ramoutar, S., Collard, A., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9897 · Cited by 371 · see citing works
Salisbury, C., Montgomery, A. A., Hollinghurst, S. P., Hopper, C. D., Bishop, A., Franchini, A., Kaur, S., Coast, J., Hall, J., Grove, S., et al. (2013) · BMJ · doi:10.1136/bmj.f43 · Cited by 82 · see citing works
Gilbert, A. W., Jaggi, A., & May, C. R. (2017) · Physiotherapy · doi:10.1016/j.physio.2017.11.217 · Cited by 65 · see citing works
Self-citationPearson, J., Richardson, J. C., Calnan, M., Salisbury, C., & Foster, N. E. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1349-y · Cited by 37 · see citing works
Gilbert, A. W., Jaggi, A., & May, C. R. (2018) · Shoulder & Elbow · doi:10.1177/1758573218796815 · Cited by 17 · see citing works
Self-citationGilbert, A. W., Jones, J., Stokes, M. J., Mentzakis, E., & May, C. R. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-035210 · Cited by 9 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Satisfaction with the use of telehealth during COVID-19: An integrative review
Andrews, E., Berghofer, K., Long, J., Prescott, A., & Caboral-Stevens, M. (2020) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2020.100008 · Cited by 216 · see citing works
Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review
Abd-Alrazaq, A., Hassan, A., Abuelezz, I., Ahmed, A., Alzubaidi, M. S., Shah, U., Alhuwail, D., Giannicchi, A., & Househ, M. (2021) · Journal of Medical Internet Research · doi:10.2196/29136 · Cited by 35 · see citing works
Pain management programmes via video conferencing: a rapid review
Walumbe, J., Belton, J., & Denneny, D. (2021) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2020-0112 · Cited by 29 · see citing works
- Authors
- Gilbert, A. W., Billany, J. C. T., Adam, R., Martin, L., Tobin, R., Bagdai, S., Galvin, N., Farr, I., Allain, A., Davies, L., & Bateson, J.
- Affiliations
- Royal National Orthopaedic Hospital NHS Trust (GB)
- Corresponding author
- Gilbert, Anthony William
- Venue
- BMJ Open Quality
- Publisher
- BMJ
- Published
- 2020-05
- Volume
- 9
- Issue
- 2
- Pages
- e000985
- ISSN
- 2399-6641 (ISSN-L)
- PMC
- PMC7247397
- OpenAlex
- W3027302907
- Cited by
- 251
- References
- 15
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 35 · 2023: 40 · 2022: 50 · 2021: 81 · 2020: 29
- FWCI
- 37.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMJ Open Quality (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research (ICA-CDRF-2017-03-025)
- Department of Health and Social Care
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- teleconsultation, telemedicine, COVID-19 pandemic, telephone consultation, video consultation, patient satisfaction, provider satisfaction, social distancing, quality improvement, process redesign
- MeSH terms
- COVID-19, United Kingdom, Hospitals, Special, Humans, Orthopedics, Pneumonia, Viral, State Medicine, Telemedicine, Coronavirus Infections, Pandemics, Quality Improvement
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
