What if… We Used a Hotel for Patients?

Contributors

The predicted hospital bed shortage

We should start by stating the obvious: the current COVID-19 crisis is unprecedented in modern times. If predictions are even partially accurate, our best preparations will still fall short of the need for hospital patient beds to handle the potential influx of people needing care.

According to The American Hospital Association, there are approximately 920,000 staffed beds in the U.S. Some studies have estimated that five to nine million infected people in the U.S. may need to be hospitalized, a third of whom might require intensive care. 

While all people who get infected will not need isolation and close physiologic monitoring, there may at least be the need for medical care at some point during the illness which likely requires more hospital rooms than are currently available nation-wide and in individual cities. The gaps between current capacity and potential demand stretch our healthcare system beyond anything imaginable.
 

What if we could utilize hotels for COVID-19 patient care and sequestration?

Knowing that our current USA hospital bed capacity will likely fall short of the need, we need to identify alternatives that can help offload the bed demand from our hospitals. What if, we could utilize hotels for COVID-19 patient care and sequestration?

As we dive into this exploration, we should start with some assumptions that will help define the rationale and potential processes required for this secondary use of a hotel.

It would be very difficult, if not impossible without time-consuming major renovations, to convert and renovate a hotel into a fully operational hospital that meets all licensing and compliance requirements. Such conversion would not be practical or quickly done, and it would be very costly.

A hotel can be converted to patient care space that is not quite a “hospital.”

While many hotel types were considered, a full-service convention hotel provides the best opportunity to quickly create and support functional patient care spaces that will be needed if the virus spreads to predicted levels. Speed of conversion will be key.

Full-service convention hotels are predominantly located in the population centers where the needs for COVID-19 treatment and sequestration may be higher and likely near major hospitals.

Hotel to Patient Care: Potential room-use conversions

Patient Types Suitable for Hotel as a patient care site

• Patients in the age range of 18 to 50
• Patients who are still ambulatory
• Patients who may have high risk family members at home
• Patients who require monitoring due to risk of progression to severe condition
• Patients who have mild symptoms and do not have adequate support or space at home prehospitalization 
• Patients who have mild symptoms and do not have adequate support or space at home post hospitalization 
• Patients who have improved symptoms or are recovering yet still require sequestration and have positive test for Covid-19 especially if beds are needed

Scenario 1: Guest Room Conversion

The guest room conversion for low acuity patients can be rather simple with a few considerations.

• Remove, if possible, non-essential furniture. This will allow for more caregiver space and other small equipment such as an IV pole, pulse oximeter and a bedside commode, if necessary.
• Utilize features already in the guest rooms such as the television, a telephone that connects to a central station, Wi-Fi connectivity, and a toilet/shower room with a sink.
• While the bed is not optimal for patient care it will accommodate the needs for the scenario of this type. It is recommended that all mattresses be fully contained within a waterproof protective wrap. Linens should be replaced as often as possible.
• If additional observation is necessary, consider off the shelf camera systems that are easy to install.

Infection control within the guest room must be addressed and is paramount to contain the further spread of the virus.

• To create a barrier between the carpet and patient care, cover the carpet with “carpet protection tape” that is readily available and can be easily changed between patients. While this is not ideal for infection control it can help to reduce the incidence of contamination and spread due to fluid ejections and spills. And, it is achievable.
• Post-COVID-19 use, all carpet should be removed and replaced before the hotel returns to standard operations.
• Stations for hand cleansing and access to personal protective equipment should be create near the entrance to each room if possible

Air Quality Considerations

• Utilize Existing Local HVAC in Patient Room Confirm that it doesn’t recirculate to other areas.
• Confirm HVAC systems serving common areas don’t recirculate air between patient care and staff areas.
• Verify bathroom exhaust location is away from outside air intakes and accessible areas. Label exhaust and notify maintenance staff if needed. Best practice would be to be 30 ft away from intakes, 10 ft above roof, and HEPA filtered if possible.
• Provide regular cleaning of equipment and provide updated training to maintenance staff.
• Modify exhaust systems and outdoor air systems to operate continuously at full capacity. Modern control systems are designed to close local dampers and slow down fan speeds when rooms are unoccupied. Dampers and fans should remain open and fans at 100% regardless of occupancy.
• Potential Enhancements
  • Increase bathroom with larger exhaust fan and/or reduce exhaust to non-critical/non-patient areas.
  • If needed provided temporary make-up air unit to supply air to the main level.
  • Bring in local recirculating HEPA filter units to the space to improve air quality and increase air changes.
  • To create a negative room, there are generally two scenarios:
    • If ventilation air is ducted direct to the room, restroom (or supplemental) exhaust must exceed the ventilation airflow.
    • If ventilation air is obtained through the corridor, the restroom exhaust will result in a negative pressure relationship.
  • Upgrades to power distribution may be required.
  • Emergency power should be reviewed. If none exists, or only limited, a mobile standby generator should be considered to maintain some level of operation in the event of a power failure.

Ballroom/Ward Configuration

Command Center Considerations

Operations in these scenarios must be highly organized and may mimic those of the emergency operations center at the associated hospital. A central location for command will be essential to maintaining operations and organizational efficiency of facility in this scenario. A large meeting room near triage and large care areas would be ideal. Or, consider a location that may have connectivity to the main phone control board in addition to office support equipment such as computers, copiers and printers.

It is likely that there will a shortage of qualified staff to support this emergency scenario. Alternative teams will be necessary because the standard caregiver-to-patient ratios will not be achievable. An additional benefit of a hotel conversion is that some guest rooms can be reserved for staff who can remain on site after their shifts, thereby reducing the likelihood of community spread. Food service on site can be provided and can support staff needs.

Using an electronic medical record system, at least initially, may be difficult due to lack of hardware, remote connectivity to systems and staff training requirements. The planners should consider use of a paper medical record system, often stored at the door/entry to each guest room or at the foot of the bed. Conversion to electronic data can come at later time. 

Closing Thoughts

This exploration is meant to ask the question, “what if?” and investigate some ideas that could be considered when facing a conversion scenario. Is must be acknowledged that this study is far from comprehensive. It does not identify or resolve all the issues that may arise in a hotel conversion scenario. Nor does it consider other hotel types such as limited service hotels, non-convention models or other building types. Most importantly, there will likely be staffing deficiencies and potential medical equipment shortages.

Systems may need modification that were not addressed as part of the study. While most convention hotels share the same programmatic spaces, they often differ in configurations and will require individual 
assessments. This analysis sets the groundwork for deeper dives into these topics, each of which will require additional study and consideration. 

This is an approach that is based on the ability to convert a non-hospital building for the use of patient care very quickly – a full-service convention hotel offers this opportunity. With the right resources and team, a conversion timeline of 10 to 14 days is reasonable.

Below are exhibits that visually begin to tell the story.
 

Key Insights: