Introduction: To date, despite the COVID-19 pandemic that led to the establishment of alternate care facilities (ACFs) in many regions throughout the United States (US), limited literature exists exploring the strengths of current US federal ACF guidelines and challenges with implementing these guidelines. Intuitively, the ability to expand hospital bed surge with ACFs is cardinal to responding to certain mass-casualty incidents and public health emergencies. Methods: A systematic review of existing literature was conducted, focusing on experiences with implementing ACFs in the US. Based on themes identified from the literature review, semi-structured interviews were conducted with ACF subject matter experts (SMEs). Transcripts from these interviews were qualitatively analyzed to identify common themes, focusing on successes, challenges, and the future direction of AFCs. Results: The comprehensive literature review identified 34 articles, representing 14 states and 16 ACFs. Articles addressed various topics involved in ACF implementation, describing leadership and coordination, staffing modes, satellite pharmacy onboarding, resource allocation, patient selection, challenges, and successes. 17 ACF SMEs were interviewed, representing 13 states and a variety of institutions, including community-based, academic, Red Cross, and federal partners. Key themes were identified for ACF implementation with sub-themes pertaining to successes, challenges, and the future of ACFs. Flexibility and adaptability, partnerships and collaborations, resource procurement and allocation, and leadership and stakeholder engagement were themes identified in all sub-theme areas. Key recommendations from SMEs include the development of a coherent strategic vision for each ACF, enhanced community engagement, ensuring early effective leadership, providing training and support, and enhancing coordination among outside partners. Conclusion: ACFs are a viable option for addressing medical surges during healthcare crises. Preplanning through local and regional partnerships, collaboration with local healthcare systems, and flexible staffing models are key for an effective activation. The proposed experiential-based best practices complement current ACF guidelines.
Ryder et al. (Sun,) studied this question.