Breakout Session 4: Clinical Operations

Alternate care facilities (ACFs) established during disaster response operations are required to deliver safe clinical care under severe operational, staffing, and infrastructure constraints. This breakout session explored real-world experiences managing clinical operations within ACFs, emphasizing lessons learned from frontline leaders responsible for patient flow, escalation of care, documentation, discharge planning, and support services. Participants described highly adaptive workflows shaped by limited laboratory, radiology, pharmacy, and electronic health record capabilities. Many sites relied on simplified triage models, selective laboratory testing, courier-based diagnostics, and external vendor partnerships to sustain operations. Clinical success was associated with integration of social work, discharge planning, culturally responsive care, and management of vulnerable populations, including patients with behavioral health and substance use disorders. Participants identified significant challenges related to fragmented medical records, EHR downtime, staffing fatigue, language barriers, and inability to replicate hospital-level ancillary services. Key recommendations included embedding social support services early in operational planning, standardizing workflows, developing culturally informed liaison infrastructure, and strengthening backup documentation training. Findings highlight that effective ACF clinical operations depend not only on medical capability, but also on flexible systems supporting communication, discharge coordination, and continuity of care during disaster conditions.