Establishing an Alternate Care Site

Considerations for temporary treatment locations—COVID-19

During this unprecedented public health event posed by the novel coronavirus, or Coronavirus Disease 2019 (COVID-19), Deloitte aims to continuously understand needs, collaborate, and identify ways to help patients, communities, care providers, and health systems.

Responding to the surge: The current landscape

In order to address the very real challenges that COVID-19 presents to our global health systems, we must innovate the way we work together, the solutions we bring, and the speed with which we operate. Through virtual collaboration and leveraging our collective assets and capabilities, we believe our nation has the ability to “flatten the curve,” even in the face of emerging healthcare capacity and resource constraints. To that end, in addition to discussing the key considerations in establishing an Alternate Care Site (ACS), we are providing a high-level checklist and links to other useful, publicly available resources that we believe can help address growing capacity issues.

It is well understood that large-scale health emergencies have the potential to overwhelm local providers and, while planning can and does occur, there are limited opportunities for an individual hospital or health system to prevent the need for patient surge capacity in response to a pandemic like COVID-19. Depending upon the severity of the incident or public health emergency and availability of resources in the community, activation of ACS may be considered to address insufficient ambulatory care or hospital capacity, as well as the need to screen and isolate select patients. However, local leaders and providers may not have an effective and efficient operational guide that aligns with everyday operations, incorporates the latest standards and/or leading practices of incident management, and integrates with other appropriate health and medical incident response plans and/or federal, state, and local requirements.

The purpose of this guide is to identify factors to help healthcare organizations and local leaders understand what an ACS is, how they can plan for and establish them, whom they should work with, and what resources are currently available.

Our take: Smart teams and tested tools

Establishing an effective ACS generally requires a multi-disciplinary team of people and tested tools that can be quickly deployed and tailored to the specific community within which it will be placed.

The expertise and understanding required to establish an effective ACS include quality, safety, and improvement standards; clinical operations and governance; supply chain and planning; health facilities commissioning and maintenance; and hospital and health system administration. These areas of expertise are often found through strategic collaboration among hospitals, across health system networks, and with trusted advisors who can help provide the innovative frameworks, tools, and solutions to effectively plan, launch, and prepare to operate the ACS.

While an ACS can take many forms, there are four basic “Demand Archetypes” that are typically deployed during an emergency response. Each of these applies a mixture of techniques and leading practices commensurate with the scope and scale of the emergency itself. Regardless of the Archetype deployed, however, there are three phases (Plan, Launch, and Prepare to Operate) within which critical considerations and decisions need to be made in order to safely and effectively address increased patient load. Adhering closely to this three-phase framework can help hospitals and health systems evaluate the available options and be more prepared to quickly execute an approach to manage increased capacity and patient flow.

A potential solution: Agile program management using a rapid action checklist

The considerations and tools discussed in this paper provide an approach for coordinating and executing rapid actions. The important next step is to put it into practice. Download this report for a checklist highlighting important steps to consider in establishing a functioning ACS. It is intended to be used as an initial guide for the critical considerations and decisions that should to be made in order to help safely and effectively address increased patient load during each phase of the decision framework described above.


Additional COVID-19 resources

Combating COVID-19 with resilience
The health and well-being of our people, our clients, and our communities is our highest priority. Learn more about Deloitte’s perspectives on how organizations can combat COVID-19 with resilience.

CentralSightTM supply chain network analytics solution
CentralSightTM is an automated platform that utilizes advanced analytic techniques to rapidly uncover and illuminate multi-tiered, geographically disaggregated supplier networks and enables clients to capture leading indicators and prevent supply chain disruptions before they occur.

PredictRiskTM database and Health360TM solution
Health360TM, Coronavirus Response Management Platform (CRMP) Module is a structured population analytics platform that can leverage social determinants of health factors to rapidly identify those geographic populations that are at highest risk for infection.

COVID-19 Rapid Response Tool, ConvergeHEALTH Connect powered by ZyterTM Solution
COVID-19 Rapid Response Tool facilitates secure private virtual patient engagement and care team collaboration through Virtual “smart” exams, patient video visits, secure file sharing, and provider-to-provider collaboration to efficiently manage patient care in a virtual environment.

US Centers for Disease Control and Prevention (CDC) guidance on ACS and isolation sites


Mark Ediger
Specialist Executive
Deloitte Consulting LLP

Clive Ballard
Senior Manager
Deloitte Consulting LLP

Jason Ormsby
Specialist Leader
Deloitte Consulting LLP

Margaret Legerton
Deloitte Consulting LLP

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