Hospital priorities towards patients are changing

Delaware hospitals are in crisis.

ChristianaCare, Bayhealth, TidalHealth Nanticoke and Saint Francis announced Monday in a joint statement that for the first time in about 130 years they will all be implement standards of care in a crisis. This means that hospitals will, among other things, begin to prioritize patient care and shift the allocation of resources.

For weeks, they have exceeded maximum capacity as Delaware experiences unprecedented hospitalizations in the latest wave of COVID-19 infections.

As part of the standard of crisis care, the focus is on saving the greatest number of lives rather than the needs of individual patients.

Cars are given one box each - two tests per box - as the New Castle County government distributes 6,500 COVID rapid test kits at its Reads Way center near New Castle on Saturday, January 8, 2022.

“Delawarens who need emergency care may not be able to get it,” Gov. John Carney said earlier this week. “It’s just a fact. It’s time for everyone to get involved and do what works.

Health officials continue to urge Delawaren to get vaccinated, wear masks and avoid large gatherings.

How did Delaware get here?

For nearly two weeks, the state has seen hospital admissions soar, reaching new highs almost every day. This week, he crossed the 700 mark.

Around the same time last year, when access to vaccines was limited, hospitalizations hovered around 430.

The state is experiencing its toughest fight against the virus, as the weekly case rate and the percentage of positive tests are at an all-time high.

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The omicron variant appears to be more transmissible than any previous strain. During Christmas week, health officials said, about 78% of samples tested in the lab were of the omicron variant.

Over the past month, Gov. John Carney and state health officials pleaded with Delawarens to take personal responsibility by getting vaccinated and wearing masks in indoor public places. The governor reinstated the mask’s mandate for most indoor public places as of Tuesday morning.

“I was hoping we would be able to accomplish this through voluntary compliance… it didn’t seem to be working,” Carney said in a briefing Tuesday. “We were pushed to the limit with our hospital number and decided to do everything possible.”

Hospitals have struggled with staffing issues since the fall. Many nurses leave the bedside or find better financial opportunities.

Some leave the profession altogether due to burnout and mental health issues, and the nurses who remained often had to care for many more patients than before.

Following the explosion of cases after Thanksgiving, emergency rooms became more crowded. Doctors and nurses have started treating an unprecedented number of COVID-19 patients, about 70% of whom are unvaccinated. Hospital leaders have started to sound the alarm bells about capacity issues.

He’s reached a breaking point.

What Do Crisis Care Standards Really Mean?

This type of care is only done in cases of extreme emergency, when resources are exhausted. Hospitals have already exhausted other options, including postponing elective medical procedures.

Health systems, state officials said, are experiencing capacity levels of 117% on average. At ChristianaCare and Beebe, that number is 130%.

This is the first time in ChristianaCare’s history that it has operated to a standard of crisis care.

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“We have been in this pandemic,” said Chief Medical Officer Dr Ken Silverstein, “we have planned these outbreaks, we have adjusted and adapted our capacity. We have emergency strategies in place.

“But we have reached the point where we are overwhelmed by the demand for our services.”

Hospitals will follow guidelines established by both the National Academy of Medicine and the Division of Public Health. In April 2020, a few weeks after the start of the pandemic, Delaware created document which includes medical, logistical and ethical guidelines on if and when this emergency occurs.

It describes the common factors that could lead to the implementation of standards of care in a crisis, which could also be triggered by a natural disaster or other drastic emergency. For healthcare facilities, they can include:

  • Non-patient areas used for patient care
  • There is an “insufficient number of qualified staff working” or staff are in jobs for which they are not trained
  • There is a lack of essential supplies, resulting in an allocation of rescue measures
  • Care does not meet usual standards

Overall, decisions made within the standards of crisis care are aimed at achieving the best outcome for a group of patients rather than focusing on individuals.

“We need to make clinical prioritization decisions,” said Silverstein, “who is eligible, who needs them most, who will benefit most from these drugs? “

How will the patients be affected?

This decision will affect all types of hospital patients. And it will probably do it in different ways.

Due to staffing issues within ChristianaCare’s diet team, not all patients will be able to get a hot meal, Silverstein said. Staff therefore prioritize patients.

The nurses who deliver medications to patients on a scheduled basis will now decide who will get the pills on time and who will have to wait a little longer.

The same can be applied to monoclonal antibodies, a treatment for high-risk COVID-19. This drug is insufficient. Staff will need to decide who gets it first.

It is likely that hospital staff will have to make even more difficult and heartbreaking decisions about life-saving treatments. State guidelines indicate how patients are to be triage, providing a scoring rubric.

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“Triage should be guided by the acute severity of the patient’s current medical condition,” the document states, “the epidemiology of the disease and the current status of any underlying medical illness that may hamper recovery” .

These decisions, the document said, should be based on “individual assessments of each patient’s survival potential upon discharge.” Healthcare workers should not take into account a patient’s quality of life prior to hospitalization, nor predict future quality of life.

“Depending on the event, the allocation of treatments may prioritize the number of patients who will recover over the number of years of life saved,” the document said.

Hospital officials are urging residents to only go to the emergency room if they are experiencing a medical emergency – not to take a COVID-19 test. Wait times in the emergency room are so long that patients are treated in the hallways.

ChristianaCare’s intensive care section chief, in a video released ahead of the governor’s briefing on Tuesday, noted how the hospital has set up an “additional” intensive care unit. He said, at the time of filming the video, that it was running at around 170% of normal.

“Everyone is really tired,” he said. “It’s a very busy weekend. Exhausting”

He then took a breath and said, “No end in sight.”

Contact Meredith Newman at (302) 256-2466 or [email protected] Follow her on Twitter at @MereNewman.

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