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'This has been a rather grim, morbid task': Eastern Idaho doctor discusses plan for crisis level care in hospitals

Idaho hospitals are not currently operating at crisis levels but could transition to such standards in the near future, according to Dr. Kenneth Krell.

BOISE, Idaho — When the COVID-19 pandemic began in March, a group of 14 physicians, community representatives, lawyers and staff members with the Idaho Dept. of Health and Welfare were coming up with a plan to prepare for the possibility of Idaho hospital capacity reaching crisis level.

That group makes up the State of Idaho Medical Advisory Committee.

Essentially what it may come down to is a scoring system to decide which patient gets medical care and which one doesn't, according to Dr. Kenneth Krell with Eastern Idaho Regional Medical Center.

"This has been a rather grim, morbid task for us to undertake to decide how we would allocate resources when they become too scare to be allocated to all deserving patients," Krell said. "We can't just look at the number of ICU beds that we have available. What we have to look at is the number of staff that are available to take care of those patients and we are quickly running out of staff in this state."

The crisis standard is essentially a scoring system in which points are assigned to patients and the points determine if and when that patient will receive care, according to Krell. 

Points, however, are only one criterion the committee examined.

"There are a lot of guidelines out there that we looked at and adapted and that includes such things as what's the patient's likelihood of surviving on an immediate basis," Krell said. "And if they don't have a likelihood of surviving compared to someone else, then they're going to be allocated to comfortable care, that is to make them comfortable."

In the instant of two patients in equal need of immediate care, tiebreakers come into play.

"Pregnant women, not having been through all your life cycles, that is a way to allocate based on age, and a number of others," Krell said. "And then if you have a tie that results at that point, then there is a lottery system to decide who gets the scarce resource."

Krell said Gov. Brad Little's statement that Idaho is at a tipping point is very telling of the COVID-19 situation.

The committee is unsure at this time if and when Idaho will reach crisis standards of care but is meeting on Tuesday, Nov. 17 to discuss those issues.

"But clearly what we hear from around the state is that resources are stretched as far as we can," Krell said. "And that we are approaching the limitation of what we can provide in terms of the usual care that we provide."

The spread of COVID-19 has already impacted one of Idaho's largest hospitals. Beginning on Monday, St. Luke's will postpone all elective surgeries until at least Dec. 25. Surgeries such as hysterectomies and knee replacements will not take place for the next six weeks.

Additionally, Saint Alphonsus has begun limiting certain surgical procedures at their Boise hospital.

The problem, however, is not so much the actual space or number of beds and equipment as it is staffing. On Monday, St. Luke's was out more than 100 staff, according to director of resource and staffing Brie Sandow.

St. Luke's is currently experiencing the highest numbers of staff illness and staff out with COVID-19 since the pandemic began in March.

The hospital is relying on their float pool of resources, backup nurses, and they've called in traveling contract nurses from out of state.  But even those are hard to come by.  

"So what we've seen now is supply and demand. These nurses are tired, they're fatigued, and they're not wanting to extend contract," Sandow said. "They want to go home and take a break, so that has presented another level of complexity because historically it has not been this much of a challenge to bring in external nurses."

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