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As a result of significant increases in both emergency department volumes, COVID-19 related admissions, and the ongoing national staffing shortage, TidalHealth has chosen to implement and follow CDC recommendations for crisis standards at TidalHealth Peninsula Regional in Salisbury, Maryland. A similar change in status was announced at TidalHealth Nanticoke in Seaford, Delaware on January 10. 

TidalHealth becomes the 13th hospital in Maryland to implement crisis standards for care. This is the first time in the 125-year history of TidalHealth that its hospitals have been operating under crisis standards of care.

The health system is experiencing occupancy levels never seen before coupled with tremendous lengths of stay, making managing the volumes of patients very challenging. The situation has been and continues to be serious not only within TidalHealth but at hospitals across the nation.

Since December 1, TidalHealth has collectively experienced over a 300% increase in admissions for COVID-19 and record-setting numbers of emergency department visits for COVID-19 related symptoms. 

Crisis standards of care are only used in time of emergency, when the demand for healthcare exceeds a hospital’s ability to provide it through normal means. Although very rarely used, they are guided by best practices, the values of the organization and ethical principles. This change in status follows emergency healthcare declarations recently by the Governors of Maryland and Delaware.

This decision comes after careful discussion and consideration, and is a move from optimal care for each person to optimized care for many. 

“We remain fully committed to providing the best and safest possible care, but it is becoming extremely challenging with the anticipated holiday surge in cases now occurring,” said Steve Leonard, PhD, MBA, FACHE, and TidalHealth CEO. “We continue to strategize best ways to reduce hospitalizations and overcrowding with our team and with other healthcare providers in our region. However, we desperately need the help of our communities. Getting vaccinated and receiving your booster can reduce the severity of illness and will help take the pressure off our extremely busy facilities.”

Currently, TidalHealth has exceeded the peak number of admissions witnessed in previous surges. Prior to implementing this change, TidalHealth had already taken steps to reduce admissions by postponing non-urgent surgeries requiring an overnight hospital stay and continues to evaluate all non-urgent surgeries. Emergency and urgent surgeries are not affected at this time. 

In crisis status, TidalHealth will keep in place its no visitation policy at both hospitals and will also continue to relocate, as necessary, members of its team to different areas and units of patient care where they are most needed and can best benefit patients and staffing requirements. Additionally, wait times may be increased for services, in particular in emergency departments.

TidalHealth continues to ask the public to only use the emergency departments at both hospitals for life-threatening issues. People with less severe illnesses or injuries should see their provider or visit one of the many immediate or urgent care facilities on Delmarva.

If you need a COVID-19 vaccination or booster shot, or are looking for a testing location, please visit these websites in Maryland, Virginia and Delaware: 

In Maryland: https://coronavirus.maryland.gov/pages/symptoms-testing
In Delaware: https://coronavirus.delaware.gov/testing/
In Virginia: https://coronavirus.delaware.gov/testing/

TidalHealth is not offering COVID-19 testing at either of its hospitals, and reminds 
everyone to please continue to wear your mask, keep your distance, and wash and sanitize your hands. 

The health system will reevaluate weekly the crisis standards of care operating status, and will move back to a traditional operating mode as soon as it is safe to do so.

What does crisis standards of care mean?

Crisis standards of care protocols are put into place when there is a need to extend the availability of key resources, while also minimizing the impact of shortages on clinical care. These protocols have been prepared and approved in advance so that we can quickly implement them in times of crisis. This is the first time in the history of TidalHealth that we have implemented these plans.

What changes for patients?

It’s important to note that patients with serious illness and injury should continue to access needed care at TidalHealth. Our focus will be on care for the sickest patients who truly require inpatient hospital treatment. Those with less serious conditions should avoid the emergency departments and seek care from their primary care provider or an urgent care center. Patients can expect longer wait times for all services and possible increased limitations on visitors and communication with loved ones. 

What does it mean for all team members?

During this period, our team members may be redeployed or asked to change regular protocols in order to better care for the sickest patients. These changes may include the frequency of imaging studies, expedited transfer and discharge processing, streamlined documentation, and the use of telemedicine to triage patients before scheduling inpatient clinic appointments. Surgeries will be limited to urgent cases that cannot otherwise be managed with more conservative measures, and the emergency department will be reserved for those with life-threatening illnesses and injuries.

Can someone still go to TidalHealth when they need care?

We are always here for those with serious illnesses and injuries. During this time, we ask those with less serious needs to go to their primary care doctor or an urgent care center. Because we are caring for so many with COVID-19, we have fewer team and fewer beds available for those with other needs, so surgeries may be postponed. We are working diligently to get back to normal care protocols as soon as possible.

How long will the crisis protocols be in place?

It is difficult to know when the need for crisis standards of care will abate. The next four to six weeks could be a very difficult time for the states of Maryland and Delaware, and the pandemic models we are seeing form the CDC and other trusted sources support this. We are closely monitoring the evolving situation and making decisions accordingly.

What can the community do to help?

The most important things the community can do is to take care of themselves. Get vaccinated and boosted. Practice the 3Ws – wear a mask, watch your distance and wash your hands. During this crisis, we ask those with less serious needs to go to their primary care doctor or an urgent care center rather than the emergency departments. Patients within the emergency department should understand that our team is working at peak capacity, and there may be longer wait times or differences in care experience. All TidalHealth care teams are focused on being able to provide the highest quality, safe care to those who need it the most. Please be patient and kind with our healthcare team members who are working under extraordinary stress and conditions.