U.S. Emergency Care Not Making the Grade: Report

Entire country is given a C- by professional group

TUESDAY, Jan. 10, 2006 (HealthDay News) -- Emergency care in the United States only deserves a C-, according to a new report.

The study, conducted by the American College of Emergency Physicians, found the emergency care system is overcrowded, provides limited access to care, and is hampered by soaring liability costs and a poor capacity to deal with public health or terrorist disasters.

The C- represents the average of grades for all 50 states and the District of Columbia. Grading was made using 50 measures for each state on a scale of "A" through "F" based on a state's support of key criteria: access to emergency care, quality and patient safety, public health and injury prevention, and medical liability environment.

The results of the first-ever National Report Card on the State of Emergency Medicine were less than impressive.

Not a single state pulled an overall A. California had the highest ranking, followed by Massachusetts, Connecticut and the District of Columbia; all four posted an overall grade of B. Arkansas, Idaho and Utah were at the bottom of the grading curve, with an overall D. Half of the states provided below-average support for their emergency medical systems, according to the report.

"A lot of people take emergency care for granted," said Dr. Frederick C. Blum, president of the American College of Emergency Physicians and a professor of emergency medicine, pediatrics and internal medicine at West Virginia University School of Medicine. "At a time when emergency-department visits are going through the roof, the number of emergency departments has declined because hospitals have found it's more economically attractive to close the emergency department than to keep it open and lose money."

Blum noted that one of the main problems for emergency care is medical liability. In many places, the cost of malpractice insurance has forced many doctors to give up their practice, he said. This trend is making it more difficult for emergency departments to get specialists to see patients in the emergency room. It also adds to the burden of emergency departments, since patients who would have gone to a specialist end up going to the emergency department instead, Blum explained.

"It puts a burden on an already overtaxed emergency care delivery system," Blum said. "There are people who wait for hours or days to get specialty care."

In terms of access to care, Blum said that an emergency care system that fails, fails for everyone, not only the poor and uninsured. "There are a lot of emergency care systems that are operating on the very edge, and it won't take very much for them to fail," he said. "There is a crisis of increased patient volume, decreased reimbursement, professional liability problems and on-call issues."

All these problems are intertwined with the quality and safety of care being given, Blum said.

To solve some of these problems, Blum believes that both state and federal action is needed, particularly in the areas of liability reform, reimbursement for emergency department visits, disaster and terrorist preparedness, and public health education and legislation.

"People tend to count on and take for granted emergency care," Blum said. "But there are a lot of problems facing the people who deliver that care."

One expert agrees that emergency care is in trouble.

"The emergency care system is in serious, but not critical, condition," said Dr. Stephen Epstein, an emergency physician at Beth Israel Deaconess Medical Center and an instructor at Harvard Medical School. "It's like musical chairs," he said. As the number of patients increases, there are fewer emergency departments. "We are running out of chairs."

Epstein noted that the problem in emergency departments is only a symptom of a larger crisis. "Hospitals have to operate at near 100 percent capacity in order to survive," he said.

Because of this, many hospitals have closed off areas and have fewer beds available. "A number of us are afraid that if we had a flu pandemic, we would not have places to hospitalize people," he said.

Epstein also believes that both state and federal laws are needed to deal with the problems highlighted in the report. Referring to the state of the national emergency care system, he said, "It's not a gentleman's C. We're in serious condition. We are hoping that rather than waiting for things to be critical, we are alerting people to the problems."

More information

The American College of Emergency Physicians can tell you more about the state of emergency medicine in the United States.

SOURCES: Frederick C. Blum, M.D., president, American College of Emergency Physicians, and professor, emergency medicine, pediatrics and internal medicine, West Virginia University School of Medicine, Morgantown; Stephen Epstein, M.D., emergency physician, Beth Israel Deaconess Medical Center, and instructor, Harvard Medical School, Boston; Jan. 10, 2006, National Report Card on the State of Emergency Medicine
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