• Define and implement workflows.

• Produce resources needed to support standard work.

• Align work with institutional and statewide stakeholders.

• Institutional leaders were identified and convened into a daily steering committee to provide oversight of the implementation team and to rapidly identify and address barriers. This allowed us to navigate and influence the internal and external environment. For example, the steering committee helped us quickly develop health information technology tools within OHSU and identify areas for alignment with public health agencies.

• Daily huddles occurred for continuous process improvement.

• Continuous research to create and organize a library of materials that are accessible to all hotline teams as well as primary care and ambulatory specialty practices at OHSU and across the state.

• Update resource daily.

• Multiple tools were used to support the needs for large group, small group, and individual work with synchronous and asynchronous communication in both text-based and audiovisual formats.

• More information can be found about the inquiry group in a separate paper.¹⁰

• Assess severity of illness and arrange appropriate disposition for patients. Disposition options include mobile testing, home care, virtual visits, referral to primary care respiratory clinic, and referral to an emergency department.

• Answer phone calls and electronic messages directed to the hotline from OHSU clinics.

• Perform symptom assessments for patients with a positive COVID-19 test.

• A centralized phone number and e-mail address were created for the hotline. Phone trees were reprogrammed to provide access points to the hotline from ambulatory clinics. The phone tree was integrated into other existing phone trees across the university as appropriate.

• Nurses participated in an initial 2-hour virtual training.

• Nurses were given telephones, laptops, and headsets to allow them to work from home.

• Goals of care scripting are provided for rapid assessment of patients before referral to the emergency department.

• Dedicated electronic health record training teams and resources were made available in real time via conferencing software to support the nurses in the first 3 weeks after hotline implementation.

• Daily huddles occur for continuous process improvement.

• Conferencing software and secure instant messaging allow constant communication among the nurses to create a collaborative culture with rapid dissemination of knowledge and peer-to-peer learning.

• Quality assurance activities are ongoing, including review of live and recorded calls and operational data about the hotline (eg, hold times, abandonment rates), and patient experience surveys are collected. A more formal evaluation is also being developed (see Table 2 for more details).

• Provide consultation to triage nurses and support in navigating difficult clinical scenarios.

• Answer clinical questions from providers across the state.

• Provider onboarding was performed remotely.

• A dynamically updated frequently asked questions document was created through an internal peer-review process to provide evidence-based answers. This work was done by the OHSU School of Medicine COVID-19 Inquiry Group.

• This work was supported by the COVID-19 Connected Care Center Reference Guide which collates workflows and protocols from across the university. This resource is dynamically updated.

• Create and update a guide with information about running an ambulatory clinic under the constraints of social distancing (eg, workflows to postpone visits, transition to virtual visits, provide education to patients and communities).

• Provide advice to statewide practice leaders navigating areas of uncertainty.

• Serve as a repository of best practices from outside institutions.