The imminent threat of a Covid-19 surge overwhelming available resources for critically ill patients prompted many state-level public health officials to rapidly develop triage protocols for scarce resources, known as Crisis Standards of Care (CSC).

It is important, however, for health care organizations to develop their own local CSC plans to address unique staff and community factors.

In Massachusetts, a working group of experts at Brigham and Women’s Hospital (BWH) developed a CSC implementation plan by engaging the hospital community, providing support to staff, and responding to changes in state-issued guidance and feedback from the hospital and broader Boston community. This process decreased clinician anxiety and increased hospital-wide understanding of the CSC process.

While challenges remain in both the conceptualization and operationalization of these guidelines, health care organizations may adopt elements of the BWH process and incorporate key lessons learned.

The identified steps were the following:

CSC Development Process
Formation of a CSC Working Group
CSC Approval Community Engagement Engagement of the Hospital Community Operationalization Plan and Execution Identification of Triage Officers and Triage Team Members Creation of a Triage Review and Oversight Committee (TROC) Tabletop exercises Development of an Electronic Medical Record (EMR) Integrated Dashboard Psychological Support Team CSC Command Center

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