The move by hospital systems in Fairbanks and across Alaska to crisis care standards lets doctors ease the impact of shortages to save the most lives, health officials said.
Crisis standards are now in effect at 20 hospitals and health care systems in Alaska, the Department of Health and Social Services announced Saturday.
The Dunleavy administration activated crisis standards of care in Alaska on Sept. 22 because of a surge in Covid cases that is outpacing every other U.S. state.
On Sunday, 1,140 Covid hospitalizations were reported in Alaska, according to a state-by-state tracker by the New York Times. New cases in Alaska have increased by 54% in the last two weeks, according to the tracker, with an average of 216 patients hospitalized daily.
At Fairbanks Memorial Hospital, one-third of in-patients were being treated for Covid-19, according to the latest hospital figures available. Of the 77 patients hospitalized, 25 had a Covid-19 diagnosis, the Fairbanks hospital reported.
Principle of saving the most lives
Crisis standards of care is a designation that lets providers determine “what is best for an entire group of patients on the principle of saving the most lives,” the National Academies of Sciences, Engineering and Medicine said.
The nonprofit is a collective of doctors and scientists that advises on health care policy in America.
At the start of the Covid pandemic in 2020, the organization articulated guiding principles for crisis standards to help hospitals and communities overwhelmed by demand. The group emphasized the importance of leaving clinical choices to health care professionals, hospitals, communities and leaders who best understand local conditions.
“In crisis standards of care, you’re not able to do everything that you would want to do for a patient,” said Dr. Angelique Ramirez, chief medical officer at Foundation Health Partners in Fairbanks.
“It means we would still do the best we possibly can, but the reality is, we couldn’t guarantee the same type of outcomes that we routinely would,” Ramirez said Friday.
To ease staffing shortages and burnout by healthcare workers, the state has signed an $87 million contract that will bring several hundred workers to Alaska that include nurses and respiratory therapists. The temporary health care workers started arriving last week.
The entire cost will be reimbursed to Alaska through the Federal Emergency Management Agency (FEMA).
Strategies for crisis standards of care
The National Academies of Sciences, Engineering and Medicine has made several recommendations for facilities addressing high caseloads of patients critically ill with Covid-19. Strategies include but are not limited to the following:
• Transferring patients at capacity-strained hospitals and nursing homes to facilities with more capacity.
• Limiting elective surgeries and routine visits in outpatient settings.
• Adjusting the number of providers to patients.
• Changing nursing care to a team-based approach.
• Deploying telemedicine and digital health solutions.
“Crisis standards of care guide decision-making (for) the best outcome for a group of patients rather than focusing on an individual patient,” according to the American Academy of Medical Colleges (AAMC), which represents more than 145,000 physicians in America.
The American Medical Association (AMA) echoed those statements. The AMA stated that triage decisions due to limited resources must be based and prioritized on medical necessity.
The AMA and other national health organizations also underscored the role of leaders with health-safety measures to mitigate the spread of Covid, including vaccinations, wearing masks in public areas, physical distancing, public messaging and limiting public gatherings.