At Fairbanks Memorial Hospital, doctors are not rationing oxygen, but they are getting ready to decide who needs care most. The hospital is responding to the record surge of infections in the community and the growing number of Covid-19 patients, including infants.
Foundation Health Partners — which oversees Fairbanks Memorial Hospital, Tanana Valley Clinic and Denali Center — described Monday what crisis standards of care looks like at the hospital. Scrambling for beds, employees, and places to transfer out patients, the hospital system shifted to crisis standards of care on Friday, getting ready to prioritize treatment for patients who will benefit from it the most.
Following the new standards, the hospital may not do everything they want to do for a patient and can’t guarantee the results they normally would, FHP Chief Medical Officer Dr. Angelique Ramirez said Monday.
“The focus transitions on how to deliver the best care for the community as a whole in the setting of a scarce resource,” she said.
How new standards will affect patients
In practice, the new standards mean that FHP health workers might need to choose who goes to an ICU bed and who goes to a regular bed — a decision the hospital recently has come very close to. Some FHP patients will have their procedure or surgery deferred, and other patients will start with outpatient treatment instead of being admitted to the hospital. Patients may also be discharged from the hospital sooner than normal, Ramirez said.
“We’ve not had to make any of those choices at this point in time,” Ramirez said, though the hospital is ready for them. “This is not how any of us want to practice, but at this particular point in time — with the number of cases that we have in our community, with the impact on our hospital capacity, the number of staff beds, the number of staff we have the resources that we have — this is what’s been required.”
How will the hospital prioritize care?
Overall, the hospital is following guidelines from the state Department of Health and Social Services, outlined in the Alaska Allocation of Scarce Resources document.
At the local level, FHP has a crisis assessment team which consists of doctors and nurses and has representation from an ethics panel on it. That team is reviewing hospital policies to make sure they are fair and equitable, Ramirez said.
If a frontline clinician is faced with a decision not covered in protocols, they would consult a triage officer to help them make that decision. The administration hopes that with sufficient protocols clinicians won’t need the triage officer’s help.
“But we want to make sure that we have that available at all times,” she added. “We’re trying to be very proactive, we’re trying to be thoughtful, we want the best outcomes for everybody.”
Why did the hospital shift to crisis standards of care?
Before Friday, the hospital already changed where and how they provided care, but at the end of the day it was essentially the same care, Ramirez said. Lack of resources, staff and transfer options led the hospital to the challenging decision to change standards of care.
“Our inability to transfer patients to other hospitals (required) our clinicians and our facility to consistently stretch our skills beyond our routine scope of practice, our routine scope of services,” Ramirez explained.
The hospital also has reached capacity across the organization, with staff routinely making decisions on how best to use their time, hospital beds and resources, such as monoclonal antibody infusions to treat Covid patients.
On Monday morning, 29 patients at the hospital were Covid-positive, including a 14-day-old infant 14, Ramirez added.
“We have had infants in the past who tested positive for Covid, but this is the first with pulmonary disease that has required treatment with steroids and antiviral agents that we usually use on adult patients,” she said. “The baby has required oxygen as well, but we do expect and hope that the infant will be discharged soon.”
The Covid-positive patients comprised 37% of all hospitalizations, “not quite double of our hospital census but getting there,” Ramirez said. Statewide, 216 patients were Covid-positive and 17 were suspected to have the virus as of Monday.
“We do function as a system, and so what’s happening in Anchorage, also impacts the care that we’re able to deliver here,” Ramirez said earlier. “There are services that we are not able to provide here and we usually partner with other communities and other institutions. And right now we are not able to do that as effectively as in the past.”
The care the hospital is providing can change day-by-day, depending on the availability of resources, Ramirez said.
Eleven people from clinical and non-clinical staff left FHP over the requirement for all employees to get a Covid-19 vaccine.
At the same time, seven new medical workers arrived at the hospital on Monday, including three nurses, two emergency department nurses and two respiratory therapists, said FHP Chief Human Resources Officer Nicole Welch. The hospital is expecting 13 more employees to arrive over the next couple of weeks.
The virus continues to surge
Over the weekend, Alaska reported one new Covid death and 2,290 new infections: 1,075 on Friday, 796 on Saturday and 419 on Sunday.
Locally, Fairbanks reported 235 new cases over the weekend, North Pole 76,and five more were reported somewhere else in the Fairbanks North Star Borough. Ester reported three new cases, as did Southeast Fairbanks Census Area, while Healy reported one.
Among other places with the highest case counts, Anchorage reported 757 new cases this weekend, Wasilla 270, Palmer 104, Eagle River 77, Northwest Arctic Borough 67, Soldotna 64 and Kenai 63. For more data, go to dhss.alaska.gov.