Background During COVID-19, rheumatology outpatients need timely access to care while social distancing. Video consults have potential to improve virtual assessments, however, some patients and providers are apprehensive about using this technology.

Objectives Provide delightful and effective video consults for 90% of new patients by July 1.

Methods We redesigned video appointments to create a seamless virtual experience. PDSA Series 1 identified improvement opportunities with a process map, fishbone, and driver diagram. PDSA Series 2 tested and implemented change ideas: digital appointment confirmations, reminders, and forms; video consults with limited pre-call testing; digital reports, requisitions, and messaging. PDSA Series 3 refined changes by decreasing reminders, increasing pre-call tests, and adding backup video platforms. Outcome measures were: 1)% consults by video, 2)% requesting more video appointments. Process measures were: 1) pre-call tests completed, 2) technical difficulties. Our balance measure was% virtual diagnoses modified after in-person visits. We collected data over ten weeks and emailed anonymized patient surveys one week after video consults. We analyzed data with run charts and descriptive statistics.

Results We scheduled 135 new consults: 120 (89%) video, 14 (10%) phone, and 1 (1%) office. Twenty-one patients (16%) did not own a video-enabled device. Pre-visit, 12 patients (10%) participated in pre-call testing. Video consults were initiated for 97% of scheduled patients; of these, 6% suffered technical difficulties, requiring a switch to phone or another video platform. Surveys were completed after 40% (48/120) of video visits: 68% of patients wanted another video appointment; 28% were ‘not sure’; 4% declined. Virtual diagnoses stayed the same for 84% (32/38) of patients with follow-up in-person assessments.

Conclusions While video consults proved effective for most patients, sociodemographic and technological barriers prevented others from participating. Next steps include improving access to video-enabled devices and providing more pre-visit training to reduce these barriers.