Hotel-to-Hospital Conversion as an Alternate Care Facility Strategy for Large-Scale Medical Surge: Development,...

Large-scale medical surges (whether arising from mass-casualty incidents [MCIs], pandemic disease, or wartime casualty repatriation) can rapidly overwhelm traditional hospital capacity. Alternate care facilities (ACFs) have been used to decompress hospital systems, yet prior configurations such as convention centers exhibit significant clinical and patient-experience limitations.

This paper describes the development, proof-of-concept validation, and operational framework of the Hotel2Hospital (H2H) Conversion Guidebook, a comprehensive resource enabling hospital emergency management professionals to rapidly convert a suitable hotel into a functional ACF capable of providing hospital-level care.

The H2H Guidebook was developed by Team Colorado, comprising emergency, hospitalist, and virtual medicine physicians, emergency management professionals, medical subject matter experts, architects, engineers, and regulatory specialists from the University of Colorado Hospital (UCH) and All Clear Emergency Management Group, funded under a Defense Health Agency (DHA) National Disaster Medical System (NDMS) Capability Pilot. The framework was informed by operational experience from COVID-19 ACF deployments in Colorado (USA). A proof-of-concept exercise conducted in 2025 at the Hyatt Regency Denver-Aurora Conference Center physically converted portions of a hotel into functional hospital spaces and validated clinical workflows through multi-disciplinary "Day-in-the-Life" simulations.

The proof-of-concept demonstrated that hotels can be successfully converted to provide general Med-Surg and intensive care unit (ICU)-level capacity within four weeks. Key advantages over traditional ACFs included private patient rooms capable of a high level of infection prevention measures, individual heating, ventilation, and air conditioning (HVAC) control, in-room bathrooms with showers, and existing hotel infrastructure supportive of hospital operations while being comprehensive enough to provide full Med-Surg and most ICU-level care. Clinical services including laboratory point-of-care testing, portable radiology, pharmacy, respiratory therapy, telehealth/virtual ICU, and electronic medical record (EMR) integration in the "live" environment were all demonstrated as operationally feasible. A wireless mesh network with cellular, cable, and satellite capabilities was successfully deployed to provide seamless information technology (IT) connectivity with UCH.

Hotel conversion represents a viable, scalable ACF strategy for prolonged medical surge events. The H2H Conversion Guidebook provides a structured, reproducible framework addressing activation, operations, and demobilization. Hospital emergency management professionals, public health agencies, and defense medical planners should consider incorporating the H2H model into sustained surge capacity planning.