Medicalized Hotel as an Alternative to Hospital Care for Management of Noncritical COVID-19

Background: Since the first wave of COVID-19, alternatives to conventional hospitalization have been proposed for the provision of different levels of care, ranging from shelter during quarantine to hospital-level medical care (1, 2).

Objective: To describe the adaptation of a hotel by a hospital-at-home team to provide hospital-level care to patients with COVID-19 during the first wave of the pandemic in Barcelona, Spain.

Methods: Hospital Clínic de Barcelona (HCB) is a 750-bed, public, tertiary teaching hospital serving 560 000 persons in the metropolitan area of Barcelona, Spain. In March 2020, the hospital-at-home unit was instructed to medicalize a hotel (“health hotel” [HH]) in downtown Barcelona. The aim of this initiative was to help decongest hospitals in the area by admitting patients with low dependency (Barthel Index score >60) and mild to severe COVID-19 from emergency departments or COVID-19 hospital wards, according to Centers for Disease Control and Prevention clinical guidelines (3).

Catalonia Plaza Hotel, a 500-bed, 4-star hotel 2 km away from HCB, was transformed into a medicalized hotel and opened for patient care from 25 March to 25 May 2020. Staff from different HCB departments were recruited and distributed into 2 medical teams for every 4 floors. Thus, 8 medical teams were formed, each with 10 to 14 patients in their care. Day teams comprised 1 attending physician, 2 additional physicians, and 2 to 4 medical doctors who had recently graduated. Day teams worked from 9:00 a.m. to 5:00 p.m., and 2 doctors were on duty from 5:00 p.m. to 9:00 a.m. Nurse teams worked 8-hour shifts and consisted of 2 nurses and 1 nurse aide per 24 patients. In addition, pharmacy, physical rehabilitation, and social work teams were set up on site during weekdays. A dedicated coordination team that included experts in logistics, infrastructure, nursing, and clinical coordination was also created. Because family visits were not allowed for safety reasons, daily telephone calls after medical rounds were made by medical staff to keep families informed.

Every health care worker was trained in COVID-19 management and personal protective measures, including personal protective equipment, before deployment. To prevent contamination, “dirty” and “clean” circuits were established. The clean circuit included entrance and exit of staff, medical supplies, catering, and cleaning. The dirty circuit focused on entrance and exit of patients, clothing and catering for patients, disposable medical equipment, and transition chambers for donning and doffing personal protective equipment. According to HCB protocol, every frontline health care worker caring for patients with COVID-19 was screened weekly for SARS-CoV-2 infection by polymerase chain reaction testing (4). The institutional review board of HCB evaluated and approved the study protocol (HCB.2020.0443).

Findings: During the study, a total of 2410 patients with COVID-19 were admitted to HCB, of whom 516 (21.4%) were transferred to the HH (Figure and Table). A total of 304 patients (58.9%) were transferred from hospital wards, whereas 196 (38%) were admitted directly from the emergency department. The cumulative median length of stay (HCB + HH) was 15 days (interquartile range, 10 to 21 days); the median stay at the HH was 9 days (interquartile range, 6 to 13 days). A total of 28 patients (5.4%) required transfer back to the hospital because of clinical deterioration or other medical complications. Two patients died after transfer back to HCB.

Figure. Flowchart of patient admission in the HH.

HH = health hotel.

Table.

Patient Characteristics and Outcomes

Discussion: Our findings suggest that medicalized hotels are a safe alternative to conventional hospitals for the care of patients with noncritical COVID-19. In addition to shelter for patients requiring isolation, these venues can provide care for those with low dependency and moderate to severe COVID-19 who require monitoring and treatment. In effect, this approach reduces pressure on hospitals and allows them to focus on patients who are more complex and critically ill.

Although the use of civil buildings as settings for quarantine is not new (5), to our knowledge, this is the first report of a medicalized hotel for hospital-level care. One advantage of using a hotel over field hospitals is that the primary infrastructure (that is, rooms, beds, and bathrooms) is in place. Given the absence of tourists and availability of facilities during the pandemic, such initiatives are also welcomed by economic authorities and the tourism sector.

Our findings provide preliminary guidance to support clinical and logistic decision making about adaptation of hotels and admission criteria to select appropriate patients. Further studies are warranted to validate these results.

Appendix: Members of the Hospital Clínic 4H Team

Andrea Arenas†, Pol Maymó†, Eugenia Butori†, Carmen Aranda†, Marta Sala*, Ana Fernández†, Cristina Escobar†, Laura Moreno†, Eva Castells*, Susana Cano†, Maribel Avalos†, Regina Garcia†, Nuria Subirana†, Jose Vicente Picón†, Magali Rodriguez†, Maria Martinez†, Alba Martinez†, Elisabeth Rosero†, David Jiménez†, Maria Asenjo† (Hospital at Home Unit, Medical and Nurse Direction); Almudena Sánchez†, Aida Alejaldre†, Sara Llufriu†, Daniela Lopera†, Patricia Buendia†, Guadalupe Fernandez†, Maria Navarro† (Neurology Service, Institut Clinic de Neurociències); Miguel Ángel Torrente†, Andrea Rivero†, Marta Cervera†, Desiré Vigo†, Alberto Fernández†, Francis Espósito†, Daniela Barreto† (Institut Clinic d'Hematologia i Oncologia); Agustí Toll†, Daniel Morgado†, Josep Riera†, Constanza Riquelme†, Andrea Combalía†, Francesc Cardellach†, Ramón Estruch†, Joaquim Fernàndez-Solà†, Marta Farré†, Josep M. Nicolás†, Alfons Lopez-Soto† (Institut Clínic de Medicina i Dermatologia); Elena Guillén†, Ana Santamaria†, Lidia Gomez†, Mònica Sorroche†, Monica Peradejordi†, Alberto Tello†, Juan M. López† (Institut Clinic de Nefrologia i Urologia); Roberto Gumucio†, Belén Massó†, Ana Belen Azuaga†, Carolina Montoya† (Institut Clinic d'Especialitats Mèdico-Quirúrgiques); Josep Miranda†, Elena Salas†, Carlos Garcia† (AGC); Gemma Martinez†, Antoni Castells†, Rosa Oliveras† (Nursing and Medical Direction); Laura Perelló†, Raquel Crespo†, Ariadna Patricia Mejía† (Centre de Diagnòstic per la Imatge); Roser Cadena†, Maria Galisteo† (Direcció de Qualitat i Seguretat Clínica); Natalia Charines†, M� Carmen Hernández†, Julia Prieto†, Laia Sarto†, Marta Jimenez†, Maria Jesús Sánchez† (Institut Clínic de Ginecologia i Obstetricia); Immaculada Sebastián†, Silvia Vidorreta†, Anna Planell† (Centre de Diagnòstic Biomèdic); Anna Campreciós†, Olga Hernando†, Carmen Tares† (Àrea Quirùrgica); Ana Mancebo† (Institut de Malalties Digestives i Metabòliques); Gemma Mercade† (Institut Clìnic de Oftalmologia); Darwin Barboza†, Emilia Abad† (Institut Clìnic Respiratori); Ana Labarta†, Jaume Gas†, Andrea Ocaña†, and Eva Martinez† (CAPSBE); all from Hospital Clínic de Barcelona, Barcelona, Spain.

* Author.

† Nonauthor contributor.