By Michelle Parker

The nation received a substandard C- for its support of emergency patients, according to The National Report Card on the State of Emergency Medicine from the American College of Emergency Physicians (ACEP).

“Overall, the report card reveals an unmistakable and disturbing finding,” says Stephen Epstein, MD, MPP, FACEP, chair of the Report Card Task Force. “The emergency care system in this nation is fraught with significant challenges and under more stress than ever before.”

ACEP President Nicholas Jouriles, MD, FACEP, says policymakers can no longer ignore what is happening in emergency rooms across the country. Calling on President Obama and Congress to make emergency patients a top priority for health care reform, Dr. Jouriles says, “Emergency medical care is the most overlooked part of our health care system, but the one everyone depends on in their hour of need. It’s time for policymakers to make strengthening emergency departments a national priority.”

The state that showed the best support for emergency patients is Massachusetts, which ranked first with the highest overall grade and the only B. The District of Columbia and Rhode Island tied for second and Maryland ranked third.

States showing the least support for emergency patients are Arkansas, which ranked last at 51st with the only overall D-, followed by Oklahoma (50th), New Mexico (49th), Nevada (48th), Oregon (47th), and Idaho (46th).

Applying the same methodology used to calculate the overall state grades, the national grades were based on population-weighted averages for each of the five report card categories. The national category grades are Access to Emergency Care: D-; Quality and Patient Safety Environment: C+; Medical Liability Environment: C-; Public Health and Injury Prevention: C; and Disaster Preparedness: C+.

ACEP’s first report card was released in 2006, and it contained 50 measures in four categories. The 2009 report card has more than twice as many with 116 objective measures and a new category for disaster preparedness, which makes it more comprehensive and useful, though not directly comparable to the 2006 report card.

A slightly different approach was taken with the 2009 report card. “This time we looked at outcome measures where possible,” Dr. Epstein explains. “For example, in 2006, we asked ‘do you have a primary seat belt law?’ For the 2009 report card, we asked ‘what percentage of residents are wearing seat belts?’ The reason is that we want to know what is working.”

Designed to provide a comprehensive and thorough look at the state of emergency care, the report card also serves as a blueprint for improvement, with eight national recommendations from a blue-ribbon panel of experts on hospital emergency care, public health, disaster preparedness, injury prevention, and emergency medical services. State report cards contain recommendations specific to their states. The national recommendations are:

• Create stronger emergency departments through national health care reform
• Alleviate boarding in emergency departments and hospital crowding
• Pass the Access to Emergency Medical Services Act
• Enact federal and state medical liability reforms
• Infuse a greater level of federal funding and support into disaster preparedness targeted for medical preparedness and response
• Increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment
• Increase support for the nation’s health care safety net
• Develop greater coordination of emergency services

Regarding health care reform, Dr. Jouriles says the focus has been on the distant future at the expense of current conditions. “In an ideal world, everyone will have a medical home,” he says, “but that won’t happen for many years to come, if ever. Meanwhile, every minute of every day people need emergency medical care, and that need is growing rapidly as our population ages and lives longer. The time for action is now.”

The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of the WellPoint Foundation and the Robert Wood Johnson Foundation. 

To see your state’s grades for each category, learn how you can help improve the state of emergency care where you live, or for more information, visit www.EmReportCard.org.