‘We’re in a tough spot:’ Idaho discusses crisis standards as children’s hospital fills

Influenza arrived in the household of Dr. Kenny Bramwell this month. The flu symptoms were still lingering in his family on Wednesday, when he talked with the Idaho Capital Sun in a video call about what this year’s unusual virus season has done to Idaho’s health care system.

Flu season seems to have returned to old patterns in Idaho — hitting around the holidays. But what’s different this year is that RSV and the COVID-19 virus are surging, too, causing a “triple-demic” that strains the nation’s children’s hospitals and has a ripple effect on overall health care capacity.

St. Luke’s Health System operates the only children’s hospital in the state and has most of Idaho’s pediatric hospital beds. Bramwell oversees those services.

For the first time in Bramwell’s memory, St. Luke’s leaders are now meeting twice a day to talk about capacity for Idaho’s youngest patients — and, just as when Idaho’s adults poured into hospitals with COVID-19 last year, St. Luke’s now must “board” patients in emergency rooms instead of checking them into the hospital right away. Only, this time, those patients are kids.

“Let’s say you’re a 6-year-old, and you have pneumonia, and we are totally full in the hospital but we think we’re going to be able to get you into a bed in the next six to seven hours,” Bramwell said. “We will keep you in the ER, waiting for your bed to open up upstairs. We almost always have a handful of patients who are boarding right now.”

In the interview Wednesday, Bramwell told the Sun that St. Luke’s administrators “start to worry” when 80% of beds are filled in a department like pediatrics.

Federal data this week showed all hospital beds for children and teens were taken, and then some. Nearly every day this month, hospitals were pushed beyond 100% capacity for young patients, including in pediatric intensive care units.

If the surges worsen, Idaho could implement “crisis standards of care” — a way of prioritizing only the most serious cases to keep from overstretching the system.

Bramwell said he and other St. Luke’s pediatric leaders met with Idaho’s crisis standards committee on Monday.

But for now, he said, St. Luke’s is getting creative to help Idaho weather the triple-demic storm without reaching that crisis point.

“We are in a tough spot already. We are, in fact, nearing full capacity every day,” he said. “We have done a number of things this year that we have done before; we’ve also done a number of things that we’ve never done before.”

Two of those things, Bramwell said, are:

• “We start to admit some of the youngest patients — say, zero to three months of age — to the NICU where normally we wouldn’t.”
• “The other thing we do is we admit older kids to adult floors. So, let’s say you’re a 16-year-old and you have pneumonia. When we’re chock full, we can admit a handful of those larger or older teens to other parts of the hospital.”

This story has been abridged. Read the complete story at IdahoCapitalSun.com.