This article is more than 5 years old. Information may no longer be current.
Mediocre grades for U.S. emergency care
Overcrowding, finances, liability and uninsured patients cited as contributors.
Click Here to Manage Email Alerts
Emergency care around the United States did not fare well in a recent American College of Emergency Physicians survey.
All 50 states scored a collective C– average. More than half the states received below-average marks in areas ranging from medical liability to communications. No state received an A or F overall.
The American College of Emergency Physicians’ (ACEP) “National Report Card on the State of Emergency Medicine” is the first national state-by-state emergency care analysis. An ACEP task force used data from government and other sources. Researchers divided 50 rating criteria into four general areas, giving each a percentage of the final grade as follows: emergency care access (40%); quality and safety (25%); public health and injury prevention (10%); and medical liability environment (25%). California, Massachusetts, Connecticut and the District of Columbia received Bs, best in the nation. Utah, Idaho and Arkansas scored Ds, the worst.
New York scored C+ overall. Pennsylvania had a B– overall. Texas scored a C. Wisconsin and Florida scored C–. Illinois had a C. Arizona got D+.
California scored high marks because of its strict seat belt laws, high adult vaccination rate and low occupational injury rate. However, California has a high number of uninsured residents and ranks last among all states in the number of emergency departments per one million residents.
Arkansas scored near the bottom in trauma centers per one million residents. The state also scored low because it has a high number of uninsured residents, does not require motorcycle riders to wear helmets and has more lenient seat belt laws than many other states.
Texas, California, Montana and Nevada scored highest on liability environment. Virginia, Arkansas and the District of Columbia scored lowest on liability. Populous states like Maryland, Pennsylvania and North Carolina also scored near the bottom. Overall, 30 states received Ds and about 12 received Fs on liability. Four states scored As.
Access, funding grow scarce
The researchers attributed the poor grades to various factors:
- The number of emergency departments decreased 14% since 1993, as the number of emergency patients has increased. Emergency departments had 114 million patient visits in 2003.
- More uninsured patients use emergency departments for primary care.
- U.S. hospitals are less able to transfer emergency patients to hospital beds. Hospitals closed 103,000 medical-surgical beds and 7800 intensive care beds in the 1990s.
- Hospital emergency departments are more crowded than ever.
- Private health insurance companies, Medicare and Medicaid are paying less for services.
The study also blamed nurse shortages, ambulance diversions and decreasing state funding, the report said.
“Not surprisingly, wealthier states have some advantages in providing emergency care, but the advantage is not as large as one might assume,” the report said. “Several lower income states showed strong policy support for emergency care and earned high grades. All states have ample room for improvement.”
Task force chair Angela Gardner noted the country's inability to handle a disaster like Hurricane Katrina or an avian flu outbreak.
For more information:
- The National Report Card on the State of Emergency Medicine, Evaluating the Environment of Emergency Care Systems State by State. Available at acep.org.