Hospitals in Idaho are so overwhelmed with the surge in coronavirus cases that doctors and nurses have to contact dozens of regional hospitals across the west in hopes of finding places to transfer individual critical patients.
The situation has gotten so bad that the Idaho Department of Health and Wellness announced Thursday that the entire state is in a hospital resource crisis, allowing medical facilities to ration health care and sort patients.
Kootenai Health, a hospital in Coeur d’Alene, Idaho, has already converted a conference room into an overflow Covid unit, started paying traveling nurses $ 250 an hour, and brought in a military medical unit. The hospital received government approval last week to begin rationing supplies. That’s all in response to the surge in Covid that has hit much of Idaho in the past few weeks – a state with one of the lowest vaccination rates in the country.
“It’s just trying hard to find a place for these patients and the care they need,” said Brian Whitlock, president and CEO of the Idaho Hospital Association, who found hospitals across the state are grappling with the same problem to have. “It’s really an up-to-the-minute estimate of where beds are open and hospitals say we don’t know where we’re going to put the next ones.”
The need for beds in the intensive care unit affects a number of patients: people suffering from Covid as well as people who, for example, have had heart attacks or strokes or have been involved in accidents.
Prior to the pandemic, experts said the lines between states in the region were blurred when it came to patient care. While many of the states are known for their beautiful scenery and sprawling grounds, access to critical medical care can be difficult for the small rural towns that adorn their countryside. The easiest access to medical treatment may be across a border rather than within a state.
However, these state lines have tightened somewhat as hospitals struggle to keep beds open to patients in their own state.
Washington state health leaders said they are trying to help their neighboring states, but they are keeping a close eye on their own bed space.
“We had to set up patient referral committees with doctors in our various hospitals to really evaluate and prioritize when talking to those facilities that are moving, to really identify who is and what is most at risk for higher care can manage where they are and what cannot be managed where they are, ”said Peg Currie, chief operating officer for Providence Health Care in Spokane, Wash., which is a 40-minute drive from Coeur d’Alene and Kootenai Health is removed.
It has become an ethical challenge as Washington has been aggressive with its Covid security measures while Idaho leaders have done little to cope with the recent surge.
It doesn’t matter what you think about Covid right now: it is important that our health system is busy.
DR. David Pate said from idaho
Dr. Doug White, the director of the University of Pittsburgh’s program of ethics and decision-making in critical illness, said that while Washington’s health services have a moral obligation to help, the need for action lies with the Idaho state government.
“Medical practice is regulated at the state level, public health is done at the state level, and in an emergency like this, I think state boundaries become very important because what we’re seeing is these very stark differences in the way people do things Washington State responded to the pandemic and how Idaho responded to the pandemic, “he said, noting that Washington’s aggressive security measures have placed the state at a disadvantage.
But the relationships between these hospitals are deep.
Dr. David Pate, a member of the Idaho coronavirus task force and past President and CEO of St. Luke’s Health System in Boise, said it was common before the pandemic for doctors to send their patients in because of the distance of Idaho’s cities from metropolitan areas Cities like Spokane, Salt Lake City, Seattle, Portland, Oregon, and other distant cities in the region. It often required the transportation of patients by plane or helicopter and close coordination between medical facilities.
Now, he said, doctors are being forced to call 30 or more hospitals in multiple states to find a bed for a single patient in hospitals with which they have little to no relationship. Some doctors in Idaho called south to Texas and east to Georgia.
“It takes seven to eight hours to call a number of hospitals to see if your potentially time-sensitive emergency patient is admitted,” said Pate. “Seven to eight hours could mean the patient will not survive.”
The relocation challenge added pressure to Idaho to institute crisis standards of care, which means doctors can sort patients based on bed availability and health workers can be brought to intensive care without special training.
For Idaho health officials, the number of hospital transfers that Kootenai Health had to decline due to the surge in Covid last week highlighted the need to change standards of care.
As a regional transfer center for patients in urgent need of critical care – typically things like car accidents, heart attacks and strokes – Kootenai Health had to reject 392 patient transfer requests in August due to the number of Covid patients. From July to the end of September last year, they refused 18 patient transfers.
Kootenai Health isn’t the only hospital implementing these new standards of care, and northern Idaho isn’t the only part of the state that may be implementing them.
When Idaho announced last week it would ration supplies in its northern region, state health and welfare director Dave Jeppesen called it a “last resort.”
Earlier this week, he said that emergency care standards for hospitals in the rest of the state are “imminent” as Idaho continues to set new records for hospital stays and patients in intensive care and on ventilators due to Covid.
“The numbers are increasing at an alarming rate and we see no peak in sight,” he said at a briefing on Tuesday.
In his announcement on Thursday, Jeppesen made a case for Idaho residents, stating that “the best way to end standards of care in a crisis is to get more people vaccinated”.
“The situation is dire,” he said. We don’t have enough resources to adequately treat patients in our hospitals, be it because of COVID-19 or a heart attack or a car accident. “
Under critical care standards, the state allows healthcare providers to make difficult decisions about the allocation and use of scarce medical resources. That means some patients could go without treatment as treatment is saved for those who are most likely to survive.
Idaho is not alone with this type of care.
Billings Clinic, a 300-bed Montana hospital, is considering introducing emergency care standards as the ICU capacity hits 150 percent. Alaska’s largest hospital, Providence Alaska Medical Center in Anchorage, said Tuesday that because of the number of patients at our hospital, they were “forced to implement emergency care standards.”
Meanwhile, Wyoming hospitals that typically lack cots are grappling with a wave of teething troubles.
Eric Boley, the president of the state’s hospital association, said they usually depend on neighboring states to take in critically ill children.
“We really don’t have any cots in our state, so we rely on the surrounding states to help us with that,” he said. “And we’re seeing a big increase in pediatric cases right now.”
It’s a frustration for health officials across the West as they struggle to get this recent surge under control.
With few signs that it will ease anytime soon, the region’s health systems could be stretched to their limits in a region of the country that remains very skeptical of Covid vaccines and masking requirements.
“It doesn’t matter what you think about Covid right now. The important thing is that our health system is at full capacity, ”said Pate of the Coronavirus Task Force in Idaho. “I just ask people to work with us for a month, six weeks – it’s fun for us. Be careful, do not get into a large crowd, wear a mask and consider vaccination. “