TABLE.

Facilitators for Rapid Translation of Protocol Into Practice

Facilitator	Details	Rationale
Flowchart for bedside care	Easy-to-read algorithm for escalation of respiratory support (See Appendix Figure)	Simplified decision-making at the bedside and reduced cognitive overload for the individual.
Multipronged dissemination	Email	Built on the historical expectation that clinicians check work email.
	Text messaging (Whatsapp)	Responded to an increase in use of the clinician text messaging group, which was leveraged to maximize reach.
	Living document for shift (Google Drive)	Allowed protocol to be uploaded to a living document that was updated in real time and designed to be used on shift.
	In-person education	Ensured everyone working a shift (physicians, residents, nurses) were acquainted with the protocol through huddles at the beginning of emergency department shifts.
Unit Reorganization	All COVID-19 patients needing substantial respiratory support grouped into a single unit	Put high-risk patients together for closer monitoring and expedited intervention, if needed. Conserved personal protection equipment.
	Interdisciplinary consultation: Rapid response team and critical care team agreed to round on unit daily and be available as needed for consults	Ensured safety of patients and provided hospitalists with additional support.
Rapid Training	Train-the-trainer sessions	Allowed rapid training and dissemination, created champions of the protocol, and reinforced dissemination efforts.
Institutional support	Supported by multiple departments (Emergency Medicine, Critical Care, Hospital Medicine, Pulmonary Medicine, Respiratory Therapy, and hospital leadership)	Promoted buy-in from clinicians and enabled protocol use throughout the spectrum of care (eg, Emergency Department, hospital floor, Intensive Care Unit)