Health care sees Crisis Standards of Care, life-saving tech, construction projects in 2021

Creating Crisis Standards of Care

The big health care story of 2021 was the creation and implementation of Idaho’s Crisis Standards of Care (CSC). CSC is guidance for rationing health care in the event of a natural disaster or other catastrophic event that may overwhelm the capacity of the health care systems to deliver care to all patients.

The story has its roots in the big health care story of 2020, which was COVID-19.

The COVID-19 pandemic arrived in Idaho like unwanted visiting relatives who overstayed their welcome. Idaho’s hospitals were pushed to their limits during the fall of 2020 as COVID-19 case numbers rose steadily through the Thanksgiving holiday. Public health officials, hospital managers and the Idaho Department of Health and Welfare (DHW) feared that the state’s hospitals would exhaust their capacity to accommodate COVID-19 patients.

This concern was fueled when both St. Luke’s Magic Valley Medical Center and Kootenai Medical Center almost exceeded their capacity due to the flood of COVID-19 patients.

In the statement announcing statewide CSC, DHW Director Dave Jeppesen remarked: “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.”

At the same time, a startling announcement arrived from the State of Utah that Idaho hospitals might lose the ability to transfer patients to neighboring Utah because that state’s hospitals were on the verge of rationing care.

As a result, the DHW consulted with health care stakeholders and developed Idaho’s CSC. The CSC were first published in November 2020. The state narrowly escaped putting the CSC into effect over the winter holidays.

By January, case counts began to fall. By July, case numbers fell so low that the entire state let out a collective sigh of relief. At an Aug. 11 press conference, Gov. Brad Little described the feeling last summer as case counts bottomed out: “My health care team has just done an incredible job. About a month and a half ago, I was going to take them all to lunch, and we were going to celebrate and I had a conflict and I couldn’t do that. And we ended up postponing it.”

The governor never did host his celebration over the demise of COVID-19 in Idaho. Everything changed when the Delta variant arrived in Idaho. As Little explained: “My coronavirus advisory board told me that viruses will do what viruses do, and what viruses do is mutate…The Delta variant and the lack of vaccine uptake in the state of Idaho have changed the trajectory that we thought we were on.”

Gov. Little, prophet

With all the enlightenment of hindsight, everyone now knows the Delta variant of COVID-19 drove the worst surge of cases Idaho has seen to date.

At his Aug. 11 press conference, Little predicted what happened in the fall of 2021 as the consequence of Idaho’s very low COVID-19 vaccination rate: “If more Idahoans do not choose to get vaccinated now and in the coming days and weeks, with the highly transmissible Delta variant now circulating widely, our epidemiologists say…case counts could continue to increase through the fall and exceed last year’s peak for daily case counts.”

That prediction came true as intensive care unit (ICU) beds across Idaho filled up with unvaccinated patients who made up more than 19 out of every 20 COVID-19 cases since May. In the Pandlehandle and North Central Public Health Districts, where the vaccination rate was less than 36%, Kootenai Health filled all its ICU beds by the end of August and resorted to converting a classroom into ICU space.

CSC put into effect

Lacking ICU beds and trained staff to support them in Idaho’s northern counties, the DHW authorized CSC for the Panhandle and North Central Public Health Districts on Sept. 7. Only a week later, the DHW extended the CSC across all of the Gem State on Sept. 16.

CSC were deactivated for most of Idaho on Nov. 22. As of Dec. 17, CSC were still in effect for the Panhandle Public Health District, which includes Kootenai, Benewah, Boundary, Bonner and Shoshone counties. County risk levels for these five counties were still rated high for all but Boundary, whose risk was rated as moderate.

AlertSense hospital transfer app: An Idaho first

Another stand-out health care story in 2021 was the creation of the first-ever automated hospital transfer app. The AlertSense Patient Transfer Coordination Tool (ACT) was funded through the Idaho Office of Emergency Management. The DHW hosts and coordinates the ACT for use by Idaho hospitals and long-term care facilities.

The app is a custom adaptation of the AlertSense software package at the request of the DHW. The most familiar use of this application is the Amber Alert system used by the Idaho State Police. AlertSense is the product of Konexus, a firm founded and based in Boise.

When a hospital needs to transfer a patient, it can send out an alert on the ACT to other facilities that receive it directly. The ACT eliminates the time-consuming process of going through a central coordinating agency or calling several different care providers one by one looking for an open bed. An example of such a transfer would be a small rural hospital with no ICU looking to transfer an accident victim who needs an ICU bed.

Caribou Memorial Hospital

The stand-out hospital story for 2021 was the conversion to nonprofit status for Caribou Memorial Hospital (CMH) in Soda Springs, a move intended to save the hospital from closing due to the costs of replacing its failing physical plant.

Idaho’s rural hospitals have adapted during hard financial times in several different ways over the last two decades. One of the largest obstacles for specifically Idaho’s county hospitals has been the precedent set by the 2006 Idaho Supreme Court decision in Frazier vs. City of Boise. This court decision forced Idaho’s cities, counties and taxing districts to take bonds for the replacement or renovation of existing aging buildings to the ballot box for supermajority approval.

As a result, some counties have opted to transfer their county hospitals to larger health systems, like the 2006 sale of the Twin Falls County-owned Magic Valley Medical Center. Others have chosen to drop their public status to become nonprofits, a step that allows a hospital to obtain commercial financing. Bingham Memorial Hospital in Bingham County and North Canyon Medical Center in Gooding County are examples of county hospitals becoming stand-alone nonprofits.

CMH is the latest county hospital to convert to nonprofit status. In an involved and drawn-out process, the county decided at the end of 2020 that the nonprofit route was the best way to save its hospital, which is the closest facility to the two phosphate plants in Caribou County as well as most of the working phosphate mines in Idaho’s phosphate patch. The next nearest hospital is 30 miles away, over two mountain passes that frequently close in the winter.

The structure that houses CMH was built in 1968. It is in dire need of repair or replacement. Some of its systems, like its elevators, are so old that replacement parts are no longer available. The county was reluctant to gamble on passing a bond measure for an estimated $25 million to build a new hospital building, which was cheaper than renovation at $30 million. A bond measure would be a gamble since Caribou County is small with limited financial resources: the county population is approximately 7,000, with an average per capita income of $39,855.

The creation of the new nonprofit was not without pain for the county. Caribou County closed the skilled nursing center at CMH on May 1. CMH became the nonprofit 501(c)3 Caribou Medical Center in August.

Notable hospital construction projects

Clearwater Valley Hospital, which is part of the Kootenai Health System, completed its first phase of renovations in June. The 1956 building had not been updated or remodeled until work started in December 2020. Among other items, the renovation included adding bathrooms inside inpatient rooms, so patients no longer had to share bathroom facilities. The project also upgraded and modernized the hospital’s HVAC utilities and its ADA compliance. Other work included an upgraded nursery and remodeled locations for respiratory therapy, stress echo, ultrasound, cardiac rehabilitation and lab services. Funding for the upgrades to the hospital were funded through a CARES Act grant.

The Power County Hospital District finished its $15 million renovation of its hospital in American Falls in March. The renovation of the 1961 structure included new ceilings and floors, a rebuilt skilled nursing facility, a new nursing station, a new laboratory, a new pharmacy and remodeled inpatient rooms. The existing emergency department was renovated and doubled in size. The project also included an all-new radiology facility, including the replacement of the 1980s-era X-ray equipment.

TheDHW opened a third state hospital in Nampa. The State Hospital West (SHW) facility replaces the former 20-bed adolescent care unit at State Hospital South in Blackfoot. The new facility opened on May 10. It serves a patient population aged 12 to 17 years old.

It has 16 beds and a staff of 65. SHW is 17,500 square feet. It had a project budget of $11 million. The new hospital was named one of Idaho Business Review’s Top Projects for 2021.

Another hospital project, the first on State Hospital South campus in Blackfoot since 1986, was replacing the nursing home that was built in 1938. The project consisted of a new building for mentally ill patients. This project received a honorable mention for Top Projects.