Delaware Hospitals Declare COVID ‘Crisis,’ Enact Crisis Protocol

A nurse with Christiana Care gives a free test for the coronavirus to a driver at the Riverfront complex on Friday, March 13, 2020, in downtown Wilmington, Delaware. Photograph by Butch Comegys / For WHYY

Citing the “unprecedented strain” from the latest COVID-19 surge, a majority of Delaware hospitals are implementing emergency rules to cope with the surge of COVID-19 patients.

ChristianaCare, Bayhealth, TidalHealth Nanticoke, and Saint Francis announced in a joint statement on Monday that they all will be implementing the rules, called Crisis Standards of Care.

This will allow the hospitals to redeploy clinical and non-clinical staff, adjust staffing ratios and change how treatment resources are distributed, according to a news release.

ChristianaCare, the largest health system in Delaware, was the first hospital to make this announcement.

The rules are implemented only during emergencies. Hospitals across the country have made similar decisions due to the number of COVID-19 hospitalizations.

“The current demand for care surpasses the normal resources that we have available,” hospital officials said in a statement. “Each of our organizations is taking steps to ensure that we are able to prioritize care for those with the greatest needs.”

Delaware’s health systems, officials said, are “stretched beyond capacity.” Hospitals are also asking residents to go to hospitals’ emergency rooms for serious health issues only.

Gov. John Carney announced on Monday that he will require Delawareans to wear a mask when inside most public places. He also deployed 70 Delaware National Guards members to assist hospitals with “non-clinical operations.”

The governor previously deployed about 110 members to train as certified nursing assistants, with the hopes they will help hospitals and long-term care facilities.

“I know we’re all exhausted by this pandemic,” Carney said in a statement. “But at the level of hospitalizations we’re seeing, Delawareans who need emergency care might not be able to get it. That’s just a fact. It’s time for everyone to pitch in and do what works.”

According to state data, the pandemic is having its worse impact yet in Delaware. The number of hospitalizations breaks records near every day, up to 714 people as of Monday.

The weekly rate of new cases has jumped by 50%. More than 1 in 4 COVID-19 tests are positive.

The ChristianaCare release defined the emergency rules as a “framework in which health care providers can modify processes or change the way resources are allocated in order to care for patients with the highest need in conditions when it is no longer possible to deliver care according to normal standards.”

This move also comes as health systems in Delaware continue to face a staffing crisis, particularly among nurses. Health care workers are leaving hospitals because of burnout or better financial opportunities.

In recent weeks, state officials have attributed staffing issues to workers being exposed to COVID-19.

ChristianaCare officials said the health system has often experienced capacity over 100% and about 40% of its patients have COVID-19. A majority of these patients, officials said, require a higher level of care.

“The health care system is under unprecedented strain,” Dr. Janice Nevin, CEO of ChristianaCare, said in the release. “Never have there been this many people in our community who need hospitalization, emergency care, and other health care services.”

The decisions made under Crisis Standards of Care, according to the Association of American Medical Colleges, focus on getting the best outcome for a group of patients as opposed to focusing on one person.

This kind of care is seen only when “resources are so depleted that functionally equivalent care is no longer possible,” according to the National Academies of Sciences, Engineering, and Medicine.

The implementation of this care requires “facility-specific decisions regarding the allocation of limited resources, including how patients will be triaged to receive life-saving care,” according to a March 2020 report.