Grading the Emergency Care System

By Clive Riddle, January 17, 2014

For the first time since 2009, the American College of Emergency Physicians (ACEP) issued their report card on the emergency care system at the state and national levels. Our grades have slipped. Their 149-page report “America’s Emergency Care Environment: A State-by-State Report Card” — examines 136 different emergency system measures in five categories, as follows:

Category	% of Overall Grade	2009 National Score	2014 National Score
Access to Emergency Care	30%	D-	D-
Quality and Patient Safety	20%	C+	C
Medical Liability Environment	20%	C-	C-
Public Health and Injury Prevention	15%	C	C
Disaster Preparedness	15%	C+	C-
Overall	100%	C-	D+

The point ACEP wishes to illustrate through the report is that the current health care system, as well as the health reform environment rely heavily upon the nation’s emergency care delivery, and the state of emergency care is not necessarily up to the task going forward.

ACEP President Dr. Alex Rosenau, tells us “there were more than 130 million emergency visits in 2010, or 247 visits per minute. People are in need, but conditions in our nation have deteriorated since the 2009 Report Card due to lack of policymaker action at the state and national levels. With so much changing in health care, emergency care has never been more important to our communities. This Report Card is a call to action.”

In the report’s state-by-state rankings, these states stand out at the top and bottom five:

District of Columbia (1st, B-) Massachusetts (2nd, B-) Maine (3rd, B-) Nebraska (4th, B-) Colorado (5th , C+)

Kentucky (47th, D) Montana (48th, D) New Mexico (49th, D) Arkansas (50th, D-) Wyoming (51st, F)

What to do about these poor grades? Here are the recommendations made in the report:

1. Protect access to emergency care as health care reforms are implemented.
2. Support programs that recognize the pivotal role emergency medicine plays in care coordination and transitions of care.
3. Reduce the incidence of hospital crowding and boarding of admitted patients in the emergency department.
4. Enact federal and state medical liability reforms that enhance timely access to quality care, particularly those that provide appropriate liability protections for EMTALA-mandated care.
5. Increase coordination and regionalization of specialized emergency services and support funding of federally authorized regional pilot programs.
6. Devote consistent federal and state funding to ensure adequate and sustainable local and regional disaster preparedness.
7. Continue to increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment.
8. Continue pursuit of state laws that help reduce the number of preventable deaths and injuries, particularly those that address traffic-related injuries and fatalities.
9. Expand access to standardized and user-friendly state and/or federal prescription drug monitoring programs to decrease unintentional deaths by drug overdose.
10. Fund graduate medical education programs that support emergency care, especially those related to addressing physician shortages in disadvantaged areas and in rural areas.
11. Support emergency medicine research, including basic, clinical, and translational research into improving the delivery of emergency care services.

Comments

[Urgent Care]

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