TABLE 1

PDSA Cycles

Time FramePDSA 1: MarchPDSA 2: AprilPDSA 3: April to MayPDSA 4: April to June
PLANFormed core QI team dedicated to telehealth
Discussed the need for virtual visit process to be rapidly implemented
Asked team members to contribute to KDD and fishbone diagram to understand barriers and where we may find points to interveneMet with PERs to understand the barriers they had been facingGathered feedback from patients and providers on the telehealth experience
Outlined needs for defining new process, facilitating provider training, tracking process, and understanding patient perceptionsConsidered strategies for incorporating fellows and multidisciplinary providers into virtual visit model
Planned wider discussion outside of the QI group
DOEstablished weekly meeting frequency for the core QI team
Defined the SMART aim
Created a process flowsheet and provider tips-and-tricks sheet
Implemented tracking queries from medical records: virtual visits, in-person visits, and no shows
Created fishbone and KDDQI meeting with fellows to elicit perspective and discuss participation
Created living document with QI processes accessible to the division
Huddled daily to review data and address scheduling issues
Gave the first division-wide update
QI team drafted letters to family to discuss the transition and created scripts for schedulers to useCreated and distributed patient and provider surveys via Research Electronic Data Capture to assess the experience of telehealth
Publicized the experience with telehealth through a division-wide webinar and subspeciality specific webinars
STUDYWeekly meetings were well attended and generated many ideasDaily huddle allowed for real- time discussion of successes and challengesCommunication around best practices for telehealth visits was crucialRoutine analysis of data through the collection period to address any time-sensitive issues and suggestions
Tracking of virtual visits revealed we were below goalMajor barriers identified included perceptions of patients and providers re the following: the utility of visits, uncertainty in scheduling processes, and need for different visit platforms for multiprovider fellow or interdisciplinary visitsLearned PERs were understaffed relative to communication volume
Uncertainty in the reliability of no-show data on the basis of how it were collected
Tips-and-tricks document was deemed helpful by provider feedback
ACTContinued tracking data of virtual visit and in-person visits and continued to troubleshoot algorithm for defining no-show rate
Brainstormed key drivers to low volume numbers
Continued to meet as a QI group
Obtained approval for alternative platform, Zoom, for multiprovider care
Brainstormed ways to improve communication with patients
Continued tracking virtual visit volume
Continued to meet with the QI group, with added fellow representation, and with the division
Redeployed clinical personnel with less in-person responsibility to communicate with families
Continued tracking virtual visit volume
Continued to meet with the QI group, PERs, and division
Considered how to improve telehealth and overcome identified challenges, including plans for home spirometry program
  • —, not applicable.