Article Text

Download PDFPDF

Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative
  1. Anthony William Gilbert1,2,
  2. Joe C T Billany3,
  3. Ruth Adam4,
  4. Luke Martin3,
  5. Rebecca Tobin3,
  6. Shiv Bagdai3,
  7. Noreen Galvin4,
  8. Ian Farr4,
  9. Adam Allain3,
  10. Lucy Davies3,
  11. John Bateson4
  1. 1 Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
  2. 2 School of Health Sciences, University of Southampton, Southampton, UK
  3. 3 Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
  4. 4 Improvement Team, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
  1. Correspondence to Anthony William Gilbert; anthony.gilbert{at}


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).

  • quality improvement
  • telemedicine
  • PDSA

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @awgilbert11, @JoeBillany

  • Contributors AWG, JCTB, RA, LM, RT, SB, AA and LD made substantial contributions to the design of the work. AWG, JCTB, RA, NG, IF and JB were involved in the collection, analysis and interpretation of data. AWG drafted the work with JCTB, RA, LM and JB. All authors critically revised the draft, gave final approval of the version to be published and are accountable for all aspects of the work. AWG is the guarantor of the manuscript.

  • Funding This quality improvement initiative was internally funded. AWG is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship for this research project (ICA-CDRF-2017-03-025).

  • Disclaimer This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    All patients were given the opportunity to feedback their experience at the end of each consultation. This data was continuously evaluated and used to inform service development.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.