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US Alaska's largest hospital implements crisis care standards

07:40  15 september  2021
07:40  15 september  2021 Source:   msn.com

Alaska's largest hospital implements crisis standards of care; Florida makes death data public after secrecy: COVID-19 updates

  Alaska's largest hospital implements crisis standards of care; Florida makes death data public after secrecy: COVID-19 updates Alaska’s largest hospital applies rations care, prioritizing resources to those patients who have the potential to benefit the most. COVID-19 updates.“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” Dr. Kristen Solana Walkinshaw, chief of staff at Providence Alaska Medical Center, wrote in a letter addressed to Alaskans distributed Tuesday.

ANCHORAGE, Alaska — Overwhelmed by a surge in COVID-19 patients, Alaska ’ s largest hospital on Tuesday implemented crisis standards of care , prioritizing resources and treatments to those patients who have the potential to benefit the most. We have been forced within our hospital to implement crisis standards of care ,” Walkinshaw wrote. Alaska , like other places, has seen a surge in coronavirus cases driven by the highly contagious delta variant. State health officials said Tuesday there were 691 new cases and six recent deaths, all Anchorage men ranging in age from 50s to 70s.

• Implement surge plans including crisis care plans • Implement facility, and participate in, HCC coordination activities, as required • Coordinate information and resource management with other facilities in the district through the HCC ALABAMA HEALTH CARE PROVIDER MUTUAL AID COMPACT The Alabama Health Care Provider Mutual Aid Compact is a non-binding agreement which outlines details for sharing resources, including staff, between healthcare facilities during/after disaster events, or, serving as an indicator for the implementation of Crisis Standards of Care when enacted.

ANCHORAGE, Alaska (AP) — Overwhelmed by a surge in COVID-19 patients, Alaska’s largest hospital on Tuesday implemented crisis standards of care, prioritizing resources and treatments to those patients who have the potential to benefit the most.

FILE - In this Wednesday, Dec. 16, 2020, file photo, a syringe containing a dose of the Pfizer COVID-19 vaccine sits in a container during a vaccine clinic at Providence Alaska Medical Center in Anchorage, Alaska. Overwhelmed by a surge in COVID-19 patients, Providence Alaska Medical Center, Alaska’s largest hospital, on Tuesday, Sept. 14, 2021, implemented crisis standards of care, prioritizing resources and treatments to those patients who have the potential to benefit the most.(Loren Holmes/Anchorage Daily News via AP, Pool, File): Virus Outbreak Alaska © Provided by Associated Press Virus Outbreak Alaska

“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” Dr. Kristen Solana Walkinshaw, chief of staff at Providence Alaska Medical Center, wrote in a letter addressed to Alaskans and distributed Tuesday.

“The acuity and number of patients now exceeds our resources and our ability to staff beds with skilled caregivers, like nurses and respiratory therapists. We have been forced within our hospital to implement crisis standards of care,” Walkinshaw wrote.

Alaska's largest hospital implements crisis care standards

  Alaska's largest hospital implements crisis care standards ANCHORAGE, Alaska (AP) — Overwhelmed by a surge in COVID-19 patients, Alaska’s largest hospital on Tuesday implemented crisis standards of care, prioritizing resources and treatments to those patients who have the potential to benefit the most. “While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” Dr. Kristen Solana Walkinshaw, chief of staff at Providence Alaska Medical Center, wrote in a letter addressed to Alaskans and distributed Tuesday.

Core Principles and Practices. The Alaska Mental Health Trust Authority (the Trust), the Department of Health and Social Services (DHSS) and other partners are evaluating the existing crisis system of care to identify models that demonstrate improved outcomes for those in behavioral health crisis . This report builds from two studies of Alaska ’ s acute behavioral health system initiated by the Trust (links below in Resources section). The Alaska State Hospital and Nursing Home Association’s (ASHNHA) Acute Behavioral Health Improvement Project examined the issue of psychiatric boarding in hospital

Crisis care seeks to provide the best care possible to the largest number of people with the resources available. New guidance about Crisis Standards of Care is now available in the AAMC’ s COVID-19 Clinical Guidance Repository. “The next few months of the pandemic, while we are awaiting “Patients who believe they need hospital or medical care in the coming weeks and months should not delay that care and should first contact their primary health care provider if they have one—or their local community health center if they don’t—to determine the best course of action,” said Janis M. Orlowski

Alaska, like other places, has seen a surge in coronavirus cases driven by the highly contagious delta variant. State health officials said Tuesday there were 691 new cases and six recent deaths, all Anchorage men ranging in age from 50s to 70s. A woman in her 60s from out-of-state also recently died in Juneau, the department said.

Health officials said statewide that there are 202 patients diagnosed with COVID-19 who are hospitalized, and nine additional patients are under investigation. Officials said 33 of these people are on ventilators.

The percentage of patients currently hospitalized with COVID-19 is 17.5%, the state reported.

At Providence, more than 30% of the adult patients that are hospitalized have tested positive. This also comes at a normally busier time of the year for Alaska hospitals.

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“ Implementation of crisis standards of care —when that is necessary—is appropriate and will, in fact, improve the quality of care that you’re able to deliver to the largest number of people.” But there are regulatory steps that the federal government could take to alleviate stress on hospitals and health systems. Reducing documentation requirements is one example. “That would alleviate some of the stress that is arising on the staff and on doctors and nurses who are actually struggling to keep up with caseloads right now,” he said.

Alaska is already challenged by a behavioral health workforce shortage which could end up being the final major barrier to achieving the goal of implementing the Crisis Now Model. Once the components of Crisis Now Model are implemented , an analysis of the resulting cost-offsets should be made associated with the reductions in detention, ED, and hospital utilization; and plans developed and implemented for the reinvestment of those savings to further buildout additional enhancements to the crisis system and to the BH continuum of care to better assure that the “back door”.

Walkinshaw noted that the state’s COVID-19 dashboard, which is routinely updated with numbers related to the virus, “isn’t equipped or designed to demonstrate the intricacies of providing medical care during this unprecedented time.”

At Providence, one of only three hospitals in a city of about 300,000 residents, officials have developed and enacted procedures to ration medical care and treatments, including dialysis and specialized ventilatory support.

The emergency room is overflowing at Providence, and she said patients wait for hours in their cars to see a doctor for emergency care.

Walkinshaw noted that what happens at the Anchorage hospitals affects the entire state since specialty care can often only be provided in the state’s largest city.

“Unfortunately, we are unable to continue to meet this need; we no longer have the staff, the space, or the beds,” Walkinshaw wrote. “Due to this scarcity, we are unable to provide lifesaving care to everyone who needs it.”

Alaska records most daily COVID cases amid healthcare strain

  Alaska records most daily COVID cases amid healthcare strain ANCHORAGE, Alaska (AP) — Alaska on Wednesday reported its highest number of new COVID-19 cases, a day after the state’s largest hospital announced it had entered crisis protocol and started rationing care. There were 1,068 new cases of COVID-19, with case counts 13% higher than last week. State officials said 201 Alaskans required hospitalization for COVID-19, and 34 of them were on ventilators in a state with limited health care capacity. “OurThere were 1,068 new cases of COVID-19, with case counts 13% higher than last week. State officials said 201 Alaskans required hospitalization for COVID-19, and 34 of them were on ventilators in a state with limited health care capacity.

Crisis standards of care give hospitals more flexibility to allocate resources based on which patients are most in need. Most individual hospitals and hospital systems don’t release their capacity data, and ADHS won’t release that information either, making only the cumulative statewide information available to the public. Bessel explained in the email that, as a result of Banner implementing its crisis standards of care plan, employees “may see changes in staffing models at your hospitals , alternate areas/sites for patient care , and providers in different roles than usual.”

Hospitals are experiencing large surges in COVID-19 patients, and intensive care units are already over capacity in many areas. In response, hospitals are canceling admissions and procedures, augmenting staffing, transferring patients, even establishing and operating alternate care sites. But these actions may not be enough. There will come a point in the crisis when these adaptations cannot compensate for the overwhelming caseload. At this point, hospitals must shift to crisis standards of care . This means making unprecedented and agonizing decisions under great uncertainty in order to

That has left patients across the state sitting in local hospitals since Providence can’t accept them for transfer.

“If you or your loved one need specialty care at Providence, such as a cardiologist, trauma surgeon, or a neurosurgeon, we sadly may not have room now. There are no more staffed beds left,” she wrote.

Walkinshaw said they expect an increase in COVID-19 cases in the next two to four weeks, causing an already stressful situation to possibly "rapidly progress to a catastrophe,” she said.

She said the single most important thing people can do is to get vaccinated. Alaska was the first state to open vaccinations to all residents. As of Monday, 56.5% of eligible Alaskans have been vaccinated.

Alaska Gov. Mike Dunleavy, a Republican who has recovered from COVID-19 and been vaccinated, said employees at Alaska hospitals are working long hours, some have left their jobs and there are capacity concerns.

Dunleavy, who never imposed a statewide mask mandate, has faced criticism in the past from some who say he hasn’t come out forcefully enough in support of vaccination.

“I urge, and I hope you guys print this, I strongly urge folks to get a vaccine, strongly urge them to do that,” he told reporters Tuesday.

Walkinshaw also asked that everyone wear masks, even if they are vaccinated and avoid unmasked activities. She also urged people who are sick or have been exposed to get tested and asked people to avoid potentially dangers activities and situations that may increase the need for emergency services of medical care.

“Unfortunately, if you are seriously injured, it is possible that there will not be a bed available at our trauma center to save your life," Walkinshaw wrote.

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Associated Press journalist Becky Bohrer contributed to this report from Juneau, Alaska.

Hospitals in West struggle to find beds for critically ill amid Covid surge .
Idaho has allowed its hospitals to establish crisis standards of care, which means doctors can triage patients dependent on bed space availability.Kootenai Health, a hospital in Coeur d’Alene, Idaho, has already converted a conference room into an overflow Covid unit, started paying traveling nurses $250 an hour, brought in a military medical unit and received permission from the state to ration care. That's all in response to the Covid surge that in recent weeks has taken over much of Idaho — a state with one of the nation's lowest vaccination rates.

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