Our systems medical, nursing, and patient safety leadership allocated 5.5 FTE for administration of this process, for daily clinician referral review (15C30 minutes per day), and to be available for questions. We began our planning Norisoboldine process after the initial EUA in November 2020, and we Norisoboldine infused our first patient on December 8, 2020. hospitalizations [3, 4]. Currently mAbs are taxpayer purchased and INHA antibody supplied without charge to institutions. Aside from evidence limits, early use limits often come from logistics around providing outpatient infusions within a short eligibility window [5, 6]. At the University of Pittsburgh Medical Center (UPMC), we chose to proceed with wide use given the public interest and early evidence of benefit. We describe our process for allocating and administering these brokers across our health systems Pennsylvania locations including 35 hospitals, several senior community facilities and skilled nursing facilities (SNFs), and numerous outpatient providers. The Pennsylvania Department of Health supplied mAbs to UPMC sites within the state weekly and as a single entity. Our central pharmacy supply shipped mAbs regularly to each hospital pharmacy associated with one of these infusion centers where the mAb was compounded for use when a patient arrived. We specifically chose outpatient infusion centers (Physique 1) for this process and avoided administration in emergency departments. We created a process seeking fair and equitable access to mAb infusion across all our sites in Pennsylvania. We modeled an mAb-weighted lottery process based on our previous similar tool used for fair allocation of remdesivir [7]; the lottery would occur during any periods where Norisoboldine demand exceeded supply or infusion chair availability. In this lottery, specific patient characteristics receive weighted odds for individual patients. We initially limited eligibility to patients 65 or older or with a body mass index of at least 35 as the available literature at the time indicated benefit in these groups specifically [3]. Patients with moderate to moderate COVID-19 symptoms for 9 days were eligible for referral. We utilized a 9-day referral limit to allow for any review or scheduling delays yet still ensure that patients could be infused within 10 days of symptom onset. Open in a separate window Physique 1. Map of UPMC hospitals. Initial COVID-19 monoclonal antibody infusion centers indicated by light purple dots. Per region, weekly COVID-19 monoclonal antibody infusion center capacity, reported as number of sites/weekly infusion chair appointments available. Abbreviations: COVID-19, coronavirus disease 2019; UPMC, University of Pittsburgh Medical Center. Figure 2 describes our mAb referral, review, allocation, and administration processes. We accepted referrals from outpatient offices, urgent care centers, emergency departments, and our senior community facilities or SNFs. For providers not affiliated with UPMC, we developed a paper-based referral form to accept referrals from non-UPMC-affiliated providers. Potential SNF candidate identification utilized a collaborative approach involving SNF medical directors, the attending physician or nurse practitioner, and the SNF nursing and contamination preventionist staff. Open in a separate window Physique 2. Referral and review process. We reviewed referrals every morning using either a physician or pharmacist to verify eligibility. After allocation, nurse coordinators communicated results with referring providers and facilitated scheduling with 12 infusion centers providing up to 295 mAb infusion appointments per week throughout Western and Central Pennsylvania. Each patient was scheduled for 3 hours to allow for patient arrival, a 60-minute infusion and 60-minute observation, and chair cleaning. We expanded availability at preexisting outpatient infusion centers and identified new sites as well. For those patients in a senior community facility or SNF, our trained nurses administer mAbs. Our systems medical, nursing, and patient safety leadership allocated 5.5 FTE for administration of this process, for daily clinician referral review (15C30 minutes per day), and to be available for questions. We began our planning process after the initial EUA Norisoboldine in November 2020, and we infused our first patient on December 8, 2020. In our initial 2 weeks, 187 patient referrals resulted in 167 (89%) eligible patients. Seventeen of the 20 ineligible patients (85%) had symptoms for 9 days before referral..