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'I'm Scared For All Of Us': Idaho Expands Crisis Standards Statewide

St. Luke's in downtown Boise.
Katherine Jones
Idaho Statesman
St. Luke's, Idaho's largest health system, requested to be able to ration medical care because it became overwhelmed with COVID-19 patients.

All hospitals in Idaho are now able to ration medical care due to an overwhelming and unabating surge of COVID-19 patients needing hospitalization.

The state extended "crisis standards of care,” which had been in place for North Idaho, statewide. It outlines how providers should ration care such as ventilators, ICU beds and staff time in a public health emergency.

“The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” said Idaho Department of Health and Welfare Director Dave Jeppesen.

The request for crisis standards came from Idaho's largest health system, St. Luke's. The day before, the hospital system was caring for 245 COVID-19, up from 180 two weeks earlier. That day, two-thirds of patients in St. Luke's intensive care unit beds had COVID-19; 97% of them were unvaccinated.

St. Luke’s health system has hired more than 800 new staff members in the last 60 days — 480 of whom are clinical workers, according to its letter to IDHW.

“Even with a larger workforce than we had prior to this surge, our staffing is not sufficient to continue providing contingency care with the very high volume of patients we are seeing and with the level of need in this patient population,” the letter reads.

The health care system on Wednesday added additional inpatient units in Boise and Nampa, as well as overflow space in the Magic Valley.

"We are out of actual hospital beds," said Sandee Gehrke, the chief operating officer at St. Luke’s Health System, during a media briefing Thursday.

"So every additional overflow area that we start to open now means that our patients are being taken care of on stretchers."

"I'm scared for all of us," said Dr. Steven Nemerson, the chief medical officer at Saint Alphonsus Health System. He said patient care will decline, simply because health care workers won't be able to attend to them quickly enough.

St. Luke’s also reports its inventory of ventilators and other breathing assistance machines is low due to so many patients needing them. It has ordered more, but warns it could run out “in the near future.”

In an internal memo outlining key talking points with staff, St. Luke’s predicted a dire situation.

“If our current projections hold, and they have been accurate to date, we will be overwhelmed by the end of September, with every bed occupied by a COVID-positive patient.”

IDHW said hospitals in the state will implement crisis standards of care according to their own policies. If a hospital is managing under current circumstances, they can continue to do so, the health department said.

North Idaho reached the tipping point last week, when Kootenai Health in Coeur d'Alene started caring for COVID-19 patients in a classroom, and health officials said southern Idaho was not far behind.

As recently as Tuesday, the Idaho Department of Health and Welfare said it expected cases and hospitalizations to continue to increase. There was no peak in sight.

What Pushed St. Luke’s Over The Edge

During a media briefing Thursday, Chris Roth, President and CEO of St. Luke’s; Dr. Jim Souza, Chief Physician Executive at St. Luke’s; and Sandee Gehrke, Chief Operating Officer at St. Luke described what hospital conditions look like currently, and what brought the health system to request crisis standards of care.

Taking Care Of Patients In Emergency Departments, Non-Traditional Settings And At Home

  • Frequently boarding patients in the emergency department for longer than six hours — known to be associated with worse outcomes
  • Stopping procedures and surgeries that “can be reasonably expected to be associated with a significant risk of permanent disability or pathology,” including related to breast cancers, endometrial cancers, prostate cancers and bladder tumors
  • Ventilating and delivering high-flow oxygen to patients in floors that aren’t frequently monitored, which can lead to alarms not being heard
  • Providing medical care, such as for sepsis and hypoxemia (an abnormally low concentration of oxygen in the blood), in emergency department waiting rooms
  • Caring for patients in imaging suites — where you would normally get an X-ray — in Nampa
  • Sending COVID-positive patients who would normally be admitted to the hospital home with oxygen and steroid prescriptions ; 350 patients are being monitored virtually at home

Bringing In Hundreds Of Additional Staffers To Work In Hospitals

  • Redeploying 300 caregivers from clinics, including primary care physicians, to hospitals
  • Redeploying non-clinical teams to help out with bedside care, where they help answer alarms, help grab supplies and turn over rooms after patients are discharged or die
  • Hiring additional employees: 802 additional providers have been hired in the last 60 days; about 450 are clinical providers. The health system is on track to receive 170 staff members from federal government
  • ICU nurses are caring for three patients each, instead of one or two

Making Do With Limited Equipment And Space

  • Using “non-invasive” ventilation devices that are “primitive” due to a lack of ventilators
  • Opening overflow units: 93 additional adult beds in the Treasure Valley and  the Magic Valley; three overflow units in both Boise and Twin Falls
  • Opening an overflow morgue in Boise
  • Transferring patients to critical access hospitals to free up space