Alternative Care Sites (ACS)
In the era of Covid-19, the need to rapidly surge hospital capacity has led many places to consider Alternate Care Sites (ACS). Nobody has all the answers, and it sometimes seems that we are building the plane while we are flying it. To bring some order to the chaos, I thought it might be helpful for this website to serve as a central location to share resources and ideas. I have started collecting links to documents with practical information which will I share here. Please contact me with thoughts or ideas of things to add!
There are several different ways that Alternate Care Sites can be used. Covid Positive Wards, Covid Negative Skilled Nursing Facilities, or Individual Rooms for People Awaiting Test results who can't safely isolate at home. I discuss each of these below. The attached document describes this more fully and the grid makes it easy to see on one page. Download ACS Proposal Download ACS Grid
Covid Positive Wards
ACS can used to house Covid positive patients with mild/moderate disease who can NOT safely isolate at home. These would be similar to the "fever wards" in Wuhan and in Korea. These people would either have mild disease as identified in outpatient care or would be recovering for Covid after hospitalization. While some people that fit this description could shelter at their homes, others who live in congregate living situations (nursing homes, shelters, multigenerational family homes, etc) will not be able to self isolate effectively. This can also support a public health strategy of quickly removing Covid Positive patients from the community to prevent further spread of the disease. Here are two articles that describe the policy. The Fangcang Hospital article has more information about how to actually do it with layouts etc. Download Fangcang Hospital article Download WSJ article
Covid Negative Skilled Nursing Care
Another type of Alternate Care Site is skilled nursing care level facility for Covid negative patients. This could be used to take medically frail people out of congregate living situations as well as offer a place for hospitals to discharge stable Covid negative patients before they are ready to go home. However, given that these patients are medically frail, they would need to be in individual rooms with air-flow systems designed to prevent disease spread between rooms.
Isolation for People Under Investigation
The third type of Alternate Care site is an isolation site for People Under Investigation (PUI). This class of people have no or mild symptoms and they may have been tested only because of close contact with a covid positive patient. This ACS would be for patients who are awaiting test results and are not able truly isolate at home. They will need to be isolated in single-occupancy rooms in a facility that has airflow that will not spread virus to other rooms. These patients mostly will have minimal nursing needs but do need to be fed. One model is to give each patient a thermometer and pulse oximeter and phone and have them report by phone to onsite nurse/provider twice a day.
Some good resources (with some opinionated comments)
Feel free to send us your resources or comments. We can use this as a platform to share information.
Good overview of things to keep in mind for ACS CDC Alternate Care Sites Infection Prevention and Control Considerations for Alternate Care Sites Website
Site that consolidates other resources related to ACS https://asprtracie.hhs.gov/technical-resources/48/alternate-care-sites-including-shelter-medical-care/47#plans-tools-and-templates
Lists of supplies and check list for evaluating spaces to use for ACS http://www.cidrap.umn.edu/sites/default/files/public/php/208/208_plan.pdf
Very useful list of potential staffing options (pages 100-103) Somewhat optimistic tools for setting up ACS without a lot of practical support. There is a list of staffing needs (also optimistic - pages 62-66); Supplies and equipment list (pages 78-91) http://www.cidrap.umn.edu/sites/default/files/public/php/258/258_acstools.pdf
Helpful ideas on crisis standards of care (not ACS specific) https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/
Lots of lists for establishing an ACS (Supplies page 31-34) http://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/preparedness-planning/_documents/alternate-care-site-sop.pdf