Anticipation, Always a Good Thing

Will Alternative Care Sites (ACS) be necessary?

Watching the epidemiologic data recording the rise of COVID cases caused by the delta variant is quite worrisome, and modelers are predicting significant new cases, hospitalizations, and deaths. The stresses and pressures of COVID forced many hospitals near to implementing Crisis Standards of Care (CSC) as they ran short on staff, supplies, and space. This was a dire circumstance and required anticipation and planning in light of current and future events to assure the quality and availability of care for those threatened by this disease.

Last year East West Protection (EWP) worked with a significant number of hospitals to develop, refine and execute CSC with positive effect. One element that worked very well in some locations was implementing and using Alternate Care Sites (ACS) to de-compress the acute care facilities. We believe that this element of the broad strategy is critical for hospitals, providers, and communities to be considering ahead of being overwhelmed by events.

During the spring and summer of 2020, the Army Corps of Engineers expended approximately $2B in constructing over 60 ACS across the country. Of those, very few were used. This failure to exploit a decompression strategy was driven by a variety of factors, including 1). Lack of involvement in hospital systems in designing, shaping, and operating these facilities; 2). The goals for the ACS, admission criteria, service offerings, and discharge plans were not designed by the medical providers and community health organizations; 3). The financial considerations to hospitals and the community were not fully addressed in most cases, and 4). Other failures to give real vitality to these facilities.

In contrast, the more successful models involved hospital and community leadership at the outset. Goals for the use of the facilities were well defined (e.g., focusing on the rehabilitation needs of patients for return to home and community). Linkage with community health and social support entities was highlighted and utilized to address a wide variety of patient and family needs that made the ACS experience a positive one rather than being perceived as “dumping” a patient into a warehousing situation. EWP worked with multiple facilities in designing and implementing successful ACS resources that were viewed by providers and staff as successful. In one case, the ACS received approximately 800 patients from over 20 hospitals in the community during its 10-week existence. Gratitude and relief were the dominant feelings among patients, and providers viewed it as one of the most rewarding experiences of their life.

Anticipation of a potential surge that might be overwhelming is needed now. Part of that anticipation should include consideration of planning for an ACS in your community and considering how such a tool could best be funded, established, and utilized in your community. It is never too early to consider the options.

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