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Idaho's Hospitals At A Breaking Point: 'It's A Lot Worse Than People Realize'

Samantha Wright
Boise State Public Radio

Dr. Megan McInerney is director of the Critical Care Unit at Saint Alphonsus Hospital in Boise. She spoke with Boise State Public Radio's Troy Oppie about what's next after state healthcare leaders gave local hospitals the go-ahead to ration care as needed due to the COVID-19 crisis.

TROY OPPIE: This is Boise State Public Radio News, I'm Troy Oppie. Hospitals statewide are now able to ration care, a move triggered by the overwhelming numbers of people needing medical care due to COVID-19 infection. Dr. Megan McInerney is director of the Critical Care Unit at St. Alphonsus Hospital in Boise. She's with us now. Dr. McInerney, what immediately changes in your ICU as a result of yesterday's crisis standards declaration?

DR. MEGHAN MCINERNEY: Right. So the actual declaration of the crisis standards of care doesn't really change what we're doing. Rather, I think that it just confirms that, and announces to the world, quite frankly, that we are in a situation where we can no longer continue providing the kinds of resources that we would provide to patients because we simply are seeing too many come through our door. So it's not like crisis standards of care was declared and then all of a sudden the way that we take care of patients is very different.

We've been adapting and adjusting the way that we take care of patients since the beginning of the surge. However, now we are recognizing that our numbers are going to continue to get worse and that our resources are going to continue to be more and more strained. So we are starting to set up plans for how to adapt our care for patients, how to change some of the ways that we care for patients, you know, because of this kind of admittance or acceptance that that we are in crisis care.

So, you know, for example, we are moving to multiple places to take care of ICU level patients that we would not usually take care of them in. And in order to do that, in order to staff that, we're going to have to change our staffing models somewhat. Right. Usually in the intensive care unit, we've got two nurses or sorry, one nurse for two patients. And we're just not going to be able to do that anymore. We're not going to be able to have one patient, you know, being or two patients being cared for by one nurse. We're going to have to change that ratio a little bit and have nurses come in from other parts of the hospital to help take care of patients. They'll be under the, you know, the assistance from and guidance with with ICU level nurses.

But but mostly it's just I see the announcement of the crisis standard of care as saying This is where we're at. It gives us somewhat some knowledge that that we are supported and backed by the state in doing what we need to do with limited resources to take care of the patients we have, and also to prioritize caring for the patients who we can actually help.

OPPIE: And so as you reallocate staff within the hospital and you bring in outside help, how are you preparing the staff? That's your reallocating to provide care to do jobs, which they might not normally be doing, even if they are clinical staff. I don't imagine changing roles as something that can be done overnight.

DR. MCINERNEY: Right. So we are going to set up an orientation type of program for our nursing staff who come in. And likewise, if we have physicians who come in and do the same to just kind of give them the basics of of what we do in the ICU, how things run in the ICU. But again, we will still have, you know, experience critical care nurses helping and overseeing the care of the patient. It will have help from noncritical care trained nurses doing things like turning patients, changing their linens right, maybe administering some medications. But but I do still want people to know that the critical care level expertize will be done by people who are trained in that field. It's going to be that we're going to need some extra hands from places, you know, other locations in the hospital to help us do all of the work for all of the patients that are coming in.

OPPIE: Yesterday's [Thursday's] statewide hospital staff call, talking about the declaration of crisis standards of care, it really struck me as I listened to doctors from across the state that this problem may be worse than we realize or worse than has been reported. Is that a fair assessment?

MCINERNEY: I 100% agree with the statement that it is a lot worse than people realize. What people might not understand is that limited resources in a health care system will impact everyone, period. Whether it be our outpatient pulmonary clinic where I saw patients this morning; we've had to cancel seeing outpatient pulmonary patients because our docs are having to go into the ICU, [and] take care of patients there.

So that's an example of how people who, you know, have done all they can to stay safe and prevent themselves from getting sick from COVID by getting vaccinated, wearing their masks, not going to large gatherings. You know, those patients are going to be impacted by this because they're not going to get to see their lung doctor for their scheduled appointment for their lung problem because their lung doctor might be in the ICU, taking care of patients in the setting of the surge.

So I think that, in general, I feel like the general population doesn't have quite an understanding of how this affects everybody and and it is a big deal and we are in a time where we have never found found ourselves before. We've never had a crisis like this to this to this degree. This is the worst surge that we have seen since the beginning of the pandemic. And yet people are going to football games, right? Large gatherings without masks on. So I don't think people understand how big a deal it is.

OPPIE: As a as a department leader, what can you do, What are you doing to try to to help support what I'm sure will be emotional, potentially devastating decisions that that your staff may have to make in the coming days or weeks or longer?

MCINERNEY: Right, that's always the challenge right of any leader. I think is is trying to have your team feel supported through a crisis like this. You know, right before talking to you, I had just walked over to the ICU. I'm not actually on in the ICU today, but I tried to stop by and check in with every single nurse who's there with my docs, who are there with the, you know, nurse managers who are there. So I think just, you know, making sure that everybody knows that we are in this together and that any difficult decisions that are made, we will back them and support them. And then we've also worked with the senior leaders of our organization to make sure that we're walking in step with each other. And we've gotten great support from our senior leaders to say, listen, when difficult decisions have to be made, we will be doing that side-by-side with the docs and delivering any challenging information side by side with the docs, right, whatever that might be. So I think just further bolstering the sense of we are a team. And we have each other's backs - we have since this started - and I've said before, this has brought our team closer for sure because we are the only ones at times who we feel like we understand each other, right? Where sometimes we feel like we're on an island, and we know that's not true. We know that there are many members of the community who are there supporting us. But, yeah.

OPPIE: We talked a few minutes ago about how the scope of this, how bad it really is, isn't necessarily widely known. And I think we're starting to get a better picture of that through some, some access reporting that we've seen in The Associated Press and the Idaho Capitol Sun some of the work done by Audrey Dutton recently. But what are people in my position missing? What wouldn't we know to ask folks like you who are on the front lines and what do you want us to know that we aren't asking?

MCINERNEY: I think, you know, we talk a lot about the importance of vaccines, and I think it is still so, so important, and I want everyone to be vaccinated, but maybe just driving home the point or asking, you know what else we can do and my answer would be we need to be wearing our masks again. And not going to large gatherings and not attending large indoor gatherings. I think that that is for now, right, that's not forever. We're not asking people to wear their masks forever. We're not asking people to abstain from gatherings forever. But we cannot continue to have the every single day increase numbers of COVID that we are seeing and have our health care system survive.

OPPIE: Dr. Meghan McInerney is a pulmonary and critical care physician at St. Alphonsus Hospital in Boise. She is also director of the critical care unit Dr. McInerney. Thanks for your time. Good luck to you and your staff and your patients.

MCINERNEY: All right. Thank you, Troy.

OPPIE: This is Boise State Public Radio News.

Troy Oppie is a reporter and local host of 'All Things Considered' for Boise State Public Radio News.

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