Rapid implementation of virtual clinics due to COVID-19
The Royal National Orthopaedic Hospital (RNOH) sees on average 11,200 face-to-face consultations a month.
Before March 2020, only 7% of outpatient clinics were delivered virtually.
The RNOH set a target of 80% virtual clinics for all outpatient attendances in response to the COVID-19 crisis.
Solution and impact
Virtual clinics (VC) were rapidly implemented with Attend Anywhere, with 87% of consultations being delivered virtually during the first six weeks.
The goal of 80% VC was set and communicated across all clinical staff. Clinical staff were asked to screen clinical lists and identify patients suitable for a VC (either a telephone consultation (TEL) or a video consultation (VID)) rather than face-to-face for the following three weeks. Software upgrades and hardware deployment began immediately and were completed within 24 hours across both RNOH sites.
Process redesign and delivery support
The COVID-19 action team was established to rapidly implement VC across the RNOH. The multidisciplinary team consisted of operational management and strategists, a project manager, quality improvement practitioners, a clinical research fellow and data management support. The team provided a variety of skills and resources to facilitate implementation.
Following the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first six 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.
The overall impact was measured through the percentage of patients undertaking VC compared with face-to-face. A combination of manual data collection of clinic lists and data taken from the RNOH patient management system was used to identify the proportion of patients undergoing VC.
A patient and clinician satisfaction questionnaire was developed to capture their experiences. This included the question: ‘how satisfied were you with the virtual clinic?’, scored out of 100. This data was supplemented with informal observation and daily floorwalking information, with changes tested through rapid Plan, Do, Study, Act (PDSA) cycles.
Attend Anywhere is a secure web-based video consultation platform which has virtual waiting room functionality. The platform can be used for patients with scheduled appointment times or for patient drop-in clinics. Patients need access to a good internet connection and either a mobile device, a tablet, desktop computer, or laptop with a web browser, a web-camera, speakers and a microphone installed.
Video consultation via a secure web-based video consultation platform.
“Patients who have used the technology seem to like it and we are getting high satisfaction scores within this group.”
Anthony William Gilbert, HEE / NIHR clinical doctoral research fellow, Royal National Orthopaedic Hospital NHS Trust
Find out more
Anthony William Gilbert, therapies department, Royal National Orthopaedic Hospital NHS Trust
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