As the SARS-CoV2 virus has surged across the US in the last month, EWP has seen increasing pressure on hospitals who are hard pressed to accommodate patients due to limitations in staff, space, and equipment. Although many facilities have invoked sophisticated resource sparing strategies, they are rapidly approaching the need to utilize crisis standards of care. One tactic being considered to avoid hitting a hopeless situation is the use of Alternate Care Sites (ACS). In the spring of 2020, many ACSs were constructed, but usage was very spare which created concerns about the utility of an ACS. EWP believes that this is correctable and the sites can be most helpful if planned and implemented with forethought.
EWP worked closely with community and hospital leadership in Boston to develop and execute an ACS that, over the course of 8 weeks (mid-April to mid-June, 2020) saw approximately 800 patients who were in the subacute phase of covid infections. “Boston Hope” as it was called, provided decompression support to over 20 hospitals, and provided very effective recovery and rehabilitation services, easing the return of patients to their home and community. EWP also worked closely with colleagues in London who used a different model for an alternate care site, providing intensive care services in a field hospital setting.
The teams in London and Boston published their approaches to establishing and operating alternate care sites in May, 2020 https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0224
We described in that article the various considerations in planning for the type of patient care to be provided, the staffing, equipment, and space considerations, and summarize our experience and the lessons observed.
EWP believes that ACSs can be a most useful asset to a community, but its purposes must be considered, and communities of providers must reach a consensus on terms of usage. Dialogue with community leadership is critical to successful implementation and outcome. When these stakeholders are in agreement on the need and usage criteria, an ACS can be very successful.