Hotel2Hospital: An extreme makeover shows how a patient surge could be handled in a crisis

When JD Naasz, RN, a UCHealth emergency department nurse, arrived at a big hotel near the University of Colorado Anschutz Medical Campus, he was astounded. “The first day I walked in, I thought, ‘This isn’t a hotel. This is a hospital,’ ” he said.

In a few weeks, parts of two floors of the Hyatt Regency Aurora-Denver Conference Center were transformed from guest and meeting rooms into a fully equipped prototype hospital, with patient rooms, two intensive care units, a nursing station, lab, pharmacy, radiology center, and electronic patient monitoring systems.

It was a “proof of concept” test executed as part of an ongoing three-year project called Hotel2Hospital, led by the CU Department of Emergency Medicine and supported by the CU Center for Combat Medicine and Battlefield (COMBAT) Research.

The research initiative is developing ways to quickly convert a hotel into a hospital in the event of a sudden surge of patients caused by war, pandemic, or natural disaster. UCHealth, the department’s clinical partner, is a collaborator.

In an extreme makeover, crews installed new flooring on top of hotel carpet, put in a network of pipes for oxygen, rolled in beds and equipment, and set up robust IT infrastructure and satellite wireless connectivity. And then teams of doctors, nurses, and technicians arrived, taking a “test drive” in a space that looked and functioned uncannily like a hospital.

Except, that is, for a few key differences: One bin in the pharmacy contained candy instead of pills. And the patients were medical manikins – lifelike models designed to replicate human anatomy and physiology. One, named Tony, kept the providers on their toes, simulating a heart-rate spike one minute, indications of sepsis the next.

Many applications

Hotel2Hospital’s leaders are Charles Little, DO, FACEP, professor of emergency medicine and medical director of emergency preparedness at UCHealth University of Colorado Hospital (UCH); and Jason Persoff, MD, SFHM, associate professor in the CU Department of Medicine’s Division of Hospital Medicine and UCH’s assistant director of emergency preparedness. Little and Persoff have frequently collaborated on research into preparedness and response during health emergencies.

The project began in 2023 with a $12.5 million U.S. Department of Defense grant for research into ways to create alternate care facilities to supplement existing hospitals during a patient surge. The department asked research teams to consider an overseas-conflict scenario where 1,000 combat casualties per day for 100 days were returning from overseas needing care.

The expectation was for the facilities, complete with medical-surgical (med-surg) and intensive care units, to be up and running in two to four weeks and be capable of operating for several months.

“The military paid for this, but there are many other applications,” Little said as he greeted visitors in a hotel meeting room converted into an ICU. In addition to the defense mission, he said, a converted hotel could be useful in patient surges caused by a domestic crisis, such as another pandemic, a natural disaster, a terrorist attack, or even a fire taking a local hospital out of commission.

According to Defense Department projections, a major patient surge caused either by a national health emergency or overseas combat could deplete national hospital-bed capacity within 10 to 12 days.

Lessons from COVID-19

“When you look at emergency preparedness in general, one of the weakest areas is the ability to rapidly expand hospital capacity during times of disaster,” Persoff says. “And that was really brought to the fore for the nation during the COVID-19 pandemic.”

During the early days of the pandemic, he says, “everyone was working toward opening up alternate care facilities to expand hospital capacity. Here, that was done at the Colorado Convention Center, which was set up as a very large, 1,000-bed facility. But it never saw a patient. For one thing, the patient numbers started to go down, but also, it was unwieldy to work in that space. All the bathrooms are along the outside walls, and getting patients there from the centralized pods was quite problematic, even if they were ambulatory.”

Persoff credits Little with coming up with the idea of using a large conference hotel as an alternative to a convention center or a big tent in surge situations.

There are many advantages to using a conference-scale hotel, Persoff says, including pre-existing private rooms with individual bathrooms and HVAC, large kitchen and laundry facilities, loading docks and freight elevators, meeting rooms big enough to accommodate ICUs, space for administrative functions, fire code requirements similar to those of a hospital, and construction sturdy enough to support heavy equipment.

“What sets this model apart is the ability to provide full ICU and med-surg care,” Persoff says. “Most other sites for alternative care facilities are very limited in what they can offer.” He says a hotel also offers better infection control and the ability to isolate patients.

Assembling Team Colorado

The first phase of the three-year Hotel2Hospital project was to develop a preliminary version of a playbook detailing how to quickly convert a hotel into a temporary hospital.

To work on the initiative, Little and Persoff assembled what they call “Team Colorado,” including clinical personnel as well as experts in project management, architecture and engineering, construction, and hospital operations. They also conducted a series of tabletop exercises to validate and refine the playbook.

The goal of the project’s second year was to transform a hotel into a simulated hospital as a trial run to test the playbook’s concepts as well as to give UCHealth providers experience in the facility and to evaluate clinical workflows.

The team chose the Hyatt Regency Aurora for the test. The site seemed ideal, given its proximity to UCH and the CU Anschutz campus. The objective was to treat the hotel as a new “tower” of UCH, plugged into UCHealth’s electronic records systems.

“The nurses who’ve been over here working say that this is like working at their hospital, so the amount of extra training and orientation is almost zero,” Persoff says. “That’s exactly what we wanted.”

Also, various groups – including medical professionals – were given tours of the converted hotel space and were asked to evaluate what they saw.

To test how fast the conversion could be completed, contractors were not allowed to pre-order anything they would need for the project, Persoff says. Also, because of UCHealth’s existing contracts with rental companies, medical supplies and equipment could be gathered quickly. “Everything we threw at the rental companies, they could have for us within a day,” he says.

‘This could save countless lives’

On July 25, after about two weeks of training exercises and demonstration tours, crews began tearing down the mock hospital – removing flooring, refinishing walls, and restoring the Hyatt Regency Aurora to its original function as a hotel.

In year three of Hotel2Hospital, starting in October, the team will update the playbook with lessons learned from the Aurora demonstration, Persoff says. Researchers also plan to meet with local officials in select cities to discuss how the playbook’s concepts can be applied in their communities.

“From a disaster preparedness perspective, this is probably the most impactful project I'll ever work on,” Persoff says. “Because of this work, we now have a blueprint to turn a hotel into a hospital-level care site in just two to four weeks. This could save countless lives during a crisis.”