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"Closing Window Of Opportunity" To Avoid Rationing Care, Idaho Hospitals Say

St. Luke's Health System

Healthleaders in Idaho say if hospital capacity continues to decline, the state may need to activate its “crisis standards of care” plan to ration care.



“We’re not in crisis conditions yet, but we are very close,” said Dr. Steven Nemerson, the chief clinical officer at Saint Alphonsus Health System, during a press conference on Tuesday.

This comes after the Utah Hospital Association said last week that it would likely need to start triaging care due to overwhelmed hospitals. 

The Idaho Crisis Standards Of Care Plan outlines who to prioritize for care when there are scarce resources. Like that of nearly all other states, Idaho’s framework emphasizes a patient’s health, likelihood of survival and age when considering whether they should be prioritized for medical care such as access to a ventilator or medications.

Idaho health officials have said throughout the pandemic that moving to a crisis standards of care scenario is the last resort.

“If we have to execute crisis standards, then it’s a demonstration of the failure of the community and our leaders to step in and basically turn this situation around," Nemerson said. 

To activate the crisis standards, the committee that wrote Idaho’s guidelines — the State of Idaho's Disaster Medical Advisory Committee — would need to ask the governor to make a declaration. During Gov. Little's press conference on Monday, State Epidemiologist Dr. Christine Hahn said the committee would possibly convenethis week. 

Hahn also said on Monday that some Idaho hospitals are in the “contingency” phase — one level below “crisis.” That means the hospitals have occasionally had to divert patients to other facilities and use supplemental staff, but actually triggering the crisis standards plan would mean the health systems would have exhausted all options. 

"We still have this closing, small window of opportunity, within which we can prevent that from happening," said Dr. Jim Souza, the chief medical officer at St. Luke's, during Tuesday's hospital press conference. He said the interventions health leaders have highlighted all along — wearing a face mask and physical distancing — will help the hospitals avoid getting to that point. 

Before hospitals reach the crisis standards of care level, they would dedicate more medical units than they do now to treating COVID-19 patients, meaning other medical care and procedures would need to be reduced. 

At St. Luke’s, that might look like closing the cardiac observation unit and setting up an intensive care unit in its place, Souza said. That would mean cardiac and vascular surgical patients wouldn't be able to get less time-sensitive procedures. St. Luke's almost had to make this move last week, and Souza said it's likely to happen soon. 

The surge in hospitalizations in other Mountain West states also has an effect on the options Idaho hospitals have.

Idaho will need to continue to come up with extra capacity within the state, health leaders said Tuesday, as Utah sent the Idaho Department of Health and Welfare a warning that it might not be open to out of state transfers for much longer. When asked where patients might be transferred after Utah, the hospital officials didn’t have a clear answer.

“Where would we divert them to?” asked Souza. “Utah has made it clear that they're not able to accept patients. Eastern Washington is rapidly filling up the hospitals in western Washington.”

When it comes to the possibility of setting up a field hospital like some other states recently have, hospital leaders said it’s unlikely at this point. They wondered where all the staff to work at such a facility would come from when nearly full hospitals are already short-staffed and struggling to find traveling nurses to meet their needs.

Find reporter Rachel Cohen on Twitter @racheld_cohen 

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