How crisis standards of care impact eastern Idaho hospitals

IDAHO FALLS — The crisis standards of care have been activated statewide for the first time during the COVID-19 pandemic.

The Idaho Department of Health and Welfare announced in a news release Thursday morning that “the massive increase of COVID-19 patients requiring hospitalization in all areas of the state has exhausted existing resources.” When crisis standards of care are in effect, people who need medical care may be treated differently from what they expect, the news release explains.

“For example, patients admitted to the hospital may find that hospital beds are not available or are in repurposed rooms (such as a conference room) or that needed equipment is not available,” IDHW stated. “They may have to wait for a bed to open, or be moved to another hospital in or out of state that has the resources they need. Or they might not be prioritized for the limited resources that are available.”

Eastern Idaho Regional Medical Center, Idaho Falls Community Hospital, Madison Memorial Hospital and Portneuf Medical Center said although the crisis standards of care are activated, they are not making any immediate hospital operational changes but will continue to monitor the COVID-19 situation.

“The statewide activation does give hospitals in southeast Idaho the flexibility in how we manage high patient volume, but it doesn’t mean we must use that flexibility,” EIRMC spokeswoman Coleen Niemann explained.

A LOOK AT THE NUMBERS

Niemann reports that 32% of EIRMC’s hospitalized medical patients — excluding pediatric units, NICU and labor and delivery departments — have COVID-19. Roughly 1/3 of the intensive care patients are currently hospitalized because of “severe COVID illness.”

EIRMC’s total adult inpatient capacity for medical care is 133 beds. While the number is constantly changing, the hospital was at full capacity in the ICU and on every general medical floor as of Thursday morning.

“We have been at or near capacity constantly for many, many weeks,” Niemann said.

Across the street at Idaho Falls Community Hospital, spokeswoman Natalie Podgorski said there are 23 COVID patients admitted with three COVID patients in the ICU. Although the ICU has seven total patients in its 16-bed ICU, it’s reached its capacity for the time being.

“The number of beds we have available (and can staff) fluctuates depending on the acuity of the patients we are treating,” Podgorski said. “While at the moment we are full, we could take care of additional patients, depending on the level of care all of the patients need.”

Madison Memorial Hospital Chief Medical Officer Dr. Clay Prince said for the past month or two there have been a “steady number of COVID patients at moderate numbers in the hospital.” There were four COVID patients at Madison Memorial Thursday morning, according to Prince. He mentioned only one of four beds in the ICU was taken, and it was by a non-COVID patient.

“Despite the fact that we’ve seen consistent COVID hospitalizations here, we still at Madison Memorial have yet to need to hospitalize a (fully) vaccinated patient,” he added.

During a news conference Thursday afternoon, Portneuf Medical Center’s CEO Jordan Herget said, “Like elsewhere in the state, our COVID census is where it was last year in the pandemic, if not much higher.”

“If we do see trends continue like they have and rates continue to go up and so on, we are at risk of implementing crisis standards of care at hospitals on the eastern side of the state,” Herget said.

HOSPITALS STRETCHED THIN DUE TO STAFFING

EIRMC, IFCH and Madison Memorial agree that staffing is the limiting factor in how many patients a hospital can care for.

Since June, EIRMC hired 115 additional staff members, but Niemann said throughout the pandemic the pool of available resources has been much more competitive than before.

“Accessing traveler nurses, seeking new graduates from nursing institutions in our region or even recruiting nationally, those levers are being pulled by every hospital in America,” Niemann stated. “We are stretched thin.”

IFCH Chief Operating Officer Casey Jackman said it’s also a struggle to find skilled professionals to fill positions such as respiratory therapists and nursing.

“There’s not as many available as there use to be,” he explained. “We’re doing everything we can to bring more people in and have been since we opened in late Nov. 2019 … We’ve been able to do that, but our utilization has kept pace with our capacity so it’s been a little difficult.”

In Rexburg, Prince said Madison Memorial hasn’t had “critical staffing shortages” but it has been tough filling open positions and being able to call in enough nurses to meet surges and demand.

“Our concern is that while even though we may have additional bed space available to care for more patients, we may not have enough staff available to care for them in the event that we experience a major surge here, which is likely to happen given what’s going on around us,” Prince mentioned.

When it comes to equipment resources, EIRMC, IFCH and Madison Memorial said they have what they need to handle patient volume.

WHO IS BEING HOSPITALIZED?

Doctors at EIRMC, IFCH and Madison Memorial said they’ve seen younger people (20s-60s) hospitalized – the majority being unvaccinated.

“This variant doesn’t necessarily affect younger people more, it’s that we now have more older people protected,” Prince said. “We’re seeing relatively more younger people being hospitalized because this new variant is much more contagious and causing much more widespread infection than the first one was.”

EIRMC Infectious Disease Specialist Dr. John Bagwell added that obesity “is a big one we’re seeing in young people … If you’re unvaccinated and obese, it’s risky if you get this.” But Bagwell mentioned there are also healthy young people who have no risk factors who end up on a ventilator.

“(The variant) is definitely more contagious,” Bagwell said. “We’re combining that with an unvaccinated population that’s fairly significant in Idaho particularly, and I think that’s the problem leading to all these hospitalizations right now.”

IFCH Infectious Disease Specialist Dr. Richard Nathan explained some patients hospitalized at IFCH are also “incredibly healthy,” while some patients smoked and others have medical conditions.

“If you met them, you wouldn’t say, ‘Oh my gosh. This is a sick person who is going to die of COVID,” Nathan said. “You’d say this is a normal everyday person.”

WHAT CAN THE COMMUNITY DO TO HELP HOSPITALS?

Nathan said the number of unvaccinated patients and patients who waited too long to seek medical help and are now hospitalized is concerning.

“There are things people can do,” he said.

The doctors at EIRMC, IFCH and Madison Memorial all mentioned antibody treatments can be given to people as a way to help prevent hospitalizations. Nathan said the treatment is done through an injection or IV infusion.

“There are treatments available for patients both who have COVID that aren’t hospitalized and for certain patients who know they have been exposed to COVID and are at high risk for getting COVID,” Prince said.

Above all, medical professionals continue to ask those who aren’t vaccinated to get vaccinated.

“It’s extremely safe. It’s been used in hundreds of millions of folks without any problems. There doesn’t seem to be any long-term problems, which I know people are worried about. Nothing has turned out so far that’s significant,” Bagwell said. “I wish we could get more people to do it.”