Idaho hospitals are so overwhelmed by the rise 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.
Kootenai Health, a hospital in Coeur d’Alene, Idaho, has already converted a conference room into a crowded Covid unit, started paying travel nurses $ 250 an hour, brought in a military medical unit and received permission from the state for rationing. It’s all in response to the rise of Covid, which in recent weeks has taken over much of Idaho – a state with one of the country’s lowest vaccination rates.
“It’s just nonstop trying to find placement for these patients and the care they need,” said Brian Whitlock, president and CEO of the Idaho Hospital Association, noting that hospitals across the state are struggling with the same problem. “It really is a minute by minute assessment of where beds are open, and hospitals say we do not know where to place the next one.”
The need for ICU bedding affects a number of patients: those suffering from Covid, as well as people who have had heart attacks or strokes or have been involved in accidents, for example.
Before the pandemic, experts said the boundaries 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 wide open terrain, access to critical medical care can be difficult for the small rural towns that point to the countryside. The easiest access to medical treatment may be across a border, rather than within a state’s borders.
However, these state borders have become a bit tighter as hospitals struggle to keep beds open for patients in their own state.
Washington state health officials said they are trying to help their neighbors, but they are keeping a close eye on their own bed.
“We have had to initiate patient placement committees with physicians at our various hospitals to really assess and prioritize – in conversation with those facilities that want to transfer – to really identify who is most at risk for higher levels of care and what can be managed where they are and what cannot be managed where they are, ”said Peg Currie, operations manager at Providence Health Care in Spokane, Washington, which is a 40-minute drive from Coeur d’Alene and Kootenai Health.
It has become an ethical challenge as Washington has been aggressive in its Covid security measures, while Idaho’s state leaders have done little to counter the recent rise.
It does not matter what you think about Covid right now: what matters is that our healthcare system is capable.
dr. david pate said about idaho
Dr. Doug White, director of the University of Pittsburgh’s program on ethics and critical illness decision-making, said that while Washington’s health services may feel a moral obligation to help, the need for action for the Idaho state government is declining.
“Medical practice is regulated at the state level, public health efforts come at the state level, and so in an emergency like this I think the state lines become very important because what we see are these very strong differences between how the State of Washington has responded to the pandemic , and how Idaho has responded to the pandemic, ”he said, noting that Washington’s aggressive security measures came at a cost to the state.
But the relationship between these hospitals goes deep.
Dr. David Pate, a member of the Idaho Coronavirus Task Force and former President and CEO of St. send their patients to cities such as Spokane, Salt Lake City, Seattle, Portland, Oregon and other remote cities in the region. It often required patients to be taken by plane or helicopter and close coordination between medical facilities.
Now, he said, doctors are forced to call 30 or more hospitals across multiple states to find a bed for a single patient in hospitals with which they have little or no relationship. Some doctors in Idaho have called as far south as Texas and as far east as Georgia.
“You take seven to eight hours to call a bunch of hospitals to see if you want to take your patient who might be facing a time-sensitive emergency,” Pate said. “Seven to eight hours can mean the patient does not survive.”
The transfer challenge has also pressured Idaho to allow its hospitals to set crisis standards for care, meaning doctors can triage patients depending on available bedding, and health professionals without special training can be brought to work at the ICU.
For Idaho’s health executives, the number of hospital transfers that Kootenai Health had to decline due to the Covid rise crystallized the need to change care standards.
A regional transfer hub for patients in urgent need of critical care – typically things like car accidents, heart attacks and strokes – Kootenai Health has had to turn down 392 patient transfer requests in August due to their number of Covid patients. From July to the end of September last year, they declined 18 patient transfers.
Kootenai Health is not the only hospital establishing these new care standards, and northern Idaho is not the only part of the state that may be implementing them.
When Idaho declared it would ration care in the northern region last week, the state’s health and welfare director, Dave Jeppesen, called it a “last resort.”
He said crisis care standards are “imminent” for hospitals in the rest of the state as Idaho continues to set new records for admissions and patients in the intensive care unit and on ventilators because of Covid.
“The numbers are rising at an alarming rate and we do not see a peak in sight,” he said at a briefing Tuesday.
Under critical standards of care, the state allows health care providers to make difficult decisions about how to allocate and use scarce medical resources so they can triage patients if necessary.
Idaho is not alone in pursuing this kind of care.
The Billings Clinic, a 300-bed hospital in Montana, is considering adopting crisis standards for care as its ICU hits 150 percent capacity. Alaska’s largest hospital, Providence Alaska Medical Center in Anchorage, said Tuesday that based on the number of patients, they had been “forced within our hospital to implement crisis care standards.”
Meanwhile, hospitals in Wyoming are not usually equipped with cribs.
Eric Boley, president of the state hospital association, said they typically rely on neighboring states to take critically ill children.
“We really do not have pediatric beds in our state, so we rely on the surrounding states to help us with them,” he said. “And we’re seeing a big increase in pediatric cases right now.”
It is a frustration for health leaders across the West as they struggle to get this latest rise under control.
With few signs that it will soon give up, the region’s health systems can be stretched to their breaking point in a region of the country that is still very skeptical of Covid vaccines and masking mandates.
“It doesn’t matter what you think about Covid right now. What matters is that our healthcare system is capable,” said Pate, of the Idaho Coronavirus Task Force. “I’m just asking people, work with us for a month, six weeks – humor us. Be careful, do not get into a large crowd, wear a mask, and please consider getting vaccinated.”