Rural hospitals often face challenges when caring for the sickest patients – those requiring breathing support, help stabilizing blood pressure and circulation, or advanced neurological monitoring.
A partnership between Sanford Health locations in Fargo, North Dakota, and much smaller Bemidji, Minnesota, is making sure Bemidji can deliver this kind of critical care.
“When patients are critically ill, it is most often not a situation where we are looking at one-time care for the patient,” said Hasrat Khan, M.D. “As we say in ICU, you just need one very critically ill patient and it’ll take you all day to make sure that person survives. It can be hour-to-hour management.”
Ready before patients arrive
Dr. Khan lauded the Bemidji staff’s ability to take on intensive care unit protocols, likening it to flying an airplane. It comes with a checklist of responsibilities that are best taken care of while the plane is on the ground – or in this case, before a patient arrives. From there, experience and expertise and attention to detail take over.
“I can’t underscore enough the importance of the bedside nursing staff in the ICU,” Dr. Khan said. “Doctors can’t be there all the time. We depend staff to monitor our patients and alert us to what is going on.”
The presence of the ICU in Bemidji comes with widespread integration that has included changes for the hospital’s respiratory therapists, pharmacists, anesthesiologists and emergency care staff members.
The impact of this critical care addition is already being felt in Bemidji. Dr. Khan estimates there are now about 35 fewer transfers from the Bemidji area to Fargo per month.
“It’s not just the Bemidji community benefiting from this,” Dr. Khan said. “It also applies to areas like the Red Lake community, the Cass Lake community and towns like Park Rapids. Previously we needed to send these people all the way to Fargo. Now it might be 10 or 20 miles to Bemidji.”
Setting up the Bemidji ICU
In 2024, Sanford Health leaders in Bemidji and Fargo formed a partnership with the intent to bring critical care closer to those in need of it.
This shared vision involved developing an ICU at Sanford Bemidji Medical Center that will make life better for those who are critically ill or injured. Instead of needing to be transferred to Fargo or some other larger hospital for treatment, patients will now be able to stay closer to their homes.
Photo by Jay Pickthorn, Sanford Health
Transitioning to an ICU has involved an effort on the part of the clinicians, nurses and staff who serve the Bemidji community.
Dr. Khan, a Fargo-based intensivist – a specialist in caring for critically ill patients in the ICU – began to lead the process of building a critical care program with financial and staffing support from Sanford Health.
“Our mission at Sanford is to care, comfort and cure, and we strive to do that in a way that is accessible, sustainable and close to the community,” Dr. Khan said. “Our vision is to be the premier rural health system in the country, and this being true to our stewardship.”
This means the Bemidji ICU can now successfully manage conditions such as:
- Shock requiring close monitoring of blood pressure and circulation
- Severe respiratory failure needing advanced ventilator support
- Kidney failure requiring dialysis in unstable patients
- Post-cardiac-arrest care, including temperature management and brain-wave monitoring, with support from local EEG technicians and specialists in Fargo
Meeting community needs into the future
With Sanford support aimed at community well-being, this effort began in earnest in the spring of 2025 and had a lot going for it.
To start with, Sanford Bemidji Medical Center was ICU-ready. More importantly, Bemidji staff was both willing and capable of taking on the additional training needed to deliver critical care.
“The staff in Bemidji was already qualified,” Dr. Khan said. “We just needed to augment the nuances of the management of critical care. The most important resource was the human resource – the interest of the staff and administration has been there from the start in providing care that is high-quality, accessible and sustainable for patients and the surrounding communities.”
Dr. Khan is proud of the critical care progress while remaining focused on future growth. Implementation of advanced ICU care will continue.
“Sanford is not in a holding pattern,” Dr. Khan said. “It is an institution that makes commitments to advances. There may be obstacles, but overcoming them is part of our success. If you have never failed, you’ll never be successful, either. We will continue to move forward with courage.”
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Posted In Bemidji, Community Impact, Emergency Medicine, Fargo, Rural Health, Specialty Care, Thought Leadership
