Amid COVID-19 overload, Providence Alaska Medical Center prioritizes care under crisis standards

Alaska’s largest hospital is now implementing crisis rules and rationing of medical care and treatment amid a number of COVID-19 patients that has forced providers to prioritize patients most likely to recover.

The chief of staff at Providence Alaska Medical Center announced the decision Tuesday in a two-page letter urging Alaska to wear masks regardless of their vaccination status, get tested, get vaccinated if they are eligible, and avoid potentially dangerous activities or situations that may result in hospitalization.

“We are out of bed. Life-saving measures will not be possible in all cases, “said Dr. Leslie Gonsette, an internal medicine hospitalist and member of Providence’s executive committee who helped draft the letter.” And that’s what we’re trying to emphasize. ” .

The letter describes an emergency room full of patients who have to wait for hours in their car and sometimes heart attack patients who do not have timely care that can save lives. Currently, Providence often declines transfer requests from peripheral rural hospitals attempting to relocate victims of strokes or strokes and has instituted a strict policy of no-visitor visits, except for non-COVID patients who die.

Some elective procedures, a category that may include tumor removal or heart valve replacement, have been delayed for months and continue to be delayed.

“People all over Alaska depend on Providence to provide medical care to people across the state. Unfortunately, we cannot continue to meet this need; we no longer have the staff, space or beds, ”wrote Providence’s chief of staff, Dr. Kristen Solana Walkinshaw, on behalf of the hospital’s medical executive committee, about 1,000 doctors, professional nurses and medical assistants .

If people need specialized care in Providence (a cardiologist, a traumatic surgeon, or a neurosurgeon), we may not have space now. There are no more staffed beds. “

[Nowhere to go: Rural hospitals struggle to transfer patients as Alaska’s COVID-19 hospitalizations hit new high]

Gov. Mike Dunleavy also urged Alaska on Tuesday to be vaccinated against COVID-19. The state reported seven more virus-related deaths, nearly record hospitalizations and nearly 700 new cases.

Dunleavy allowed the state declaration of emergency COVID-19 to expire in April and last week refused to declare another, instead of filing bills to restore lost telehealth options and streamline background of health workers. Legislation died in the Alaska home after losing support when a Sunday night vote added an amendment that could have prevented hospitals from limiting patient visits.

Anchorage Mayor Dave Bronson last week he said he will not ask residents to get vaccinated, to issue a mask warrant or request other COVID-19 restrictions. Bronson also said hospital capacity problems were not caused by COVID-19 patients, but nurses quit their jobs above vaccination requirements.

“The nurses are not leaving here because of the vaccination orders. They are leaving because they are overwhelmed by the emotional toll that is going on, ”said Gonsette, the Providence hospitalist, in an interview on Tuesday. “Part of it, we all feel it, is because we are not heard. The audience wants to bury their head in the sand or maybe some of them don’t know what’s going on. They are the ones we try to achieve ”.

The rising case rate means hospitalizations for COVID-19 are likely to increase in the next two to four weeks, the letter says. “What is already a stressful situation could quickly move towards a catastrophe.”

The hospital “can no longer provide standard care to each and every one of the patients who need our help,” he continues. “Acuity and the number of patients now exceed our resources and our ability to care for beds with qualified caregivers, such as nurses and respiratory therapists. We have been forced in our hospital to apply crisis care standards.”

More than 30% of adults hospitalized in Providence were COVID positive as of Tuesday. Patients with the virus demand more care that they consume more time than most others, providers say.

The shift to crisis standards means the hospital must “prioritize scarce resources and treatments to patients who have the potential to benefit more,” the letter states. This means enacting policies and procedures for ration care and treatment, including dialysis and specialized ventilatory support.

According to Gonsette, the hospital developed its crisis care standards at the start of the pandemic in March 2020. Last week, Providence organized a triage ethics committee to help doctors cope with “difficult decisions.” to say. The board of the executive committee decided to issue the letter during an emergency meeting on Sunday.

Gonsette said attention to rationing does not mean denying care to unvaccinated people. Rather, it is about decisions based on where limited resources go and who benefits the most.

[Read the letter: How you can keep stress off of Alaska’s overburdened hospitals]

Providence issued a statement Tuesday after the letter appeared saying that “current demands for acute care at our hospital and the state of Alaska exceed available capacity and require difficult options regarding the allocation of specific treatments or resources. maintenance of patients and on the transfer of patients to higher levels of care.As a result of this situation, health care providers and centers are currently experiencing limitations in their ability to provide the standard of care. “We want to provide our community and we hope to provide it. This situation may persist for some time, which has forced us to use developed processes to ensure a more equitable allocation of limited resources.”

It was not immediately known if the other two main Anchorage hospitals planned to follow suit.

Idaho public health leaders announced last week that they have activated crisis care standards that allow rationing of health care in hospitals in the north of the state because there are more patients with coronavirus than institutions can bear.

State health officials said last week that they were talking to hospitals about the resources they needed, as well as other states, including Idaho.