Massachusetts Ranked #2 for Emergency Medical Care in U.S.

Monday, January 20, 2014

Kate Nagle, GoLocal Contributor

Massachusetts was recently named the second highest ranked state in the nation for its emergency medical care system by the American College of Emergency Physicians, earning plaudits in particular for its public health and injury prevention.

"Massachusetts does particularly well in the areas of public health and injury prevention. This reflects low death rates from motor vehicle crashes (good seatbelt and helmet laws) and other unintentional causes (firearms, poisoning, occupational accidents, etc.) as well as strong programs to protect children and the elderly (immunizations, etc.)," said Dr. Nathan MacDonald, President of the Massachusetts College of Emergency Physicians, and Chief of Emergency Medicine, Lowell General Hospital. "We also do well in Quality and Patient safety with a good EMS system and triage policies that allow ambulances to bring patients to centers with specialized capabilities for treating trauma, stroke, and heart attacks."

Slides: See How Massachusetts was Graded BELOW

The Massachusetts Nurses Association, however, took issue with the rankings. "It's inaccurate as far as we're concerned, because the ER departments are dramatically understaffed, and patients are waiting for hours, sometimes days," said David Schildmeier with the Massachusetts Nurses Association. "I don't know how they did this survey. There isn't enough staff in the hospitals to move the patients."

ACEP noted that from 1993 to 2003, the number of visits to emergency departments increased 26 percent, from 90.3 million to 113.9 million, according to the Centers for Disease Control and Prevention. During the same time period, the number of hospital emergency departments decreased by 14.1 percent, resulting in dramatic increases in patient volumes and waiting time.

Strengths, Challenges Identified

MacDonald note that Massachusetts was looking to address areas where it could improve its emergency care.

"Massachusetts hospitals should continue to work on preserving access to care, meaning that emergency physicians and specialists are readily available regionally (not just in urban teaching hospitals). This in part relates to our poor grade in Medical Liability Environment (a D-!) that can cause specialists (especially trauma, neurosurgery, ENT, plastic surgery, hand surgery) to be unwilling or unavailable to be on-call for emergency departments," said MacDonald. "This can lead to patients needing to be transferred to tertiary care facilities more often leading to potential delays and increased costs."

MacDonald continued, "Massachusetts also needs to ensure that we have adequate surge capacity especially in terms of our disaster preparedness. We received a "C" in this category. Even though we saw a tremendously effective response to the Marathon Bombing and have much to be proud of there, we have relatively few "extra beds" available if there was a widespread disaster especially outside of the immediate Boston area."

The ACEP report noted that Massachusetts "must work to improve its medical liability environment" -- which with MacDonald agreed.

"Many states have already put medical liability reforms in place while Massachusetts lags far behind. The danger is that critical specialists will no longer be "on call" for emergencies or choose to practice elsewhere in the country. Likewise, costs increase with the practice of defensive medicine. The "disclosure, apology, and offer" project [in MA] is similar to a system already in place in Michigan. The idea is to increase transparency by immediately disclosing to a patient or family when an adverse event occurs, acknowledgment and apology by hospitals or physicians, and then a reasonable offer of restitution if it is determined that an error was made," said MacDonald.

"This would drastically shorten the time between an adverse event and closure for patients and physicians compared with the current trial system, takes much of the adversarial nature out of the current malpractice system, and would make restitution more reasonable in terms of actual costs incurred rather than the large "non-economic" damages that are sometimes awarded now. This system has great promise and could have the dual effect of strengthening the patient-doctor relationship as well as reducing overall health care costs related to high malpractice insurance premiums and costly trials."

Nurses Address Issues

"As far as nurses are concerned, emergency care is not where it needs to be," said MNA's Schildmeier. "I'm shocked that Massachusetts got a number two ranking."

Schildmeier noted that MNA was continuing to pursue getting a ballot initiative to call for "safe limits on nurses' assignments."

At the end of last year, nursing advocates submitted over 100,000 signatures to the Secretary of State's office to get the "Patient Safety Act" on the November 2014 ballot, which is an initiative to "set a safe maximum limit on the number of patients assigned to a nurse at one time, while also providing maximum flexibility to hospitals to adjust nurses’ patient assignments based on the specific needs of the patients," according to the MNA.

At the time of signature delivery, the MNA said, "The filing of the initiative follows the release of dozens of prominent research studies and reports that show beyond any doubt the need to set a maximum limit on the number of patients that can be assigned to each registered nurse at one time if we are to avoid -- mistakes, serious complications and preventable readmissions. To view these studies and to learn more about the initiative, visit PatientSafetyAct.com."

Of seeking a ballot solution to the issues, Schildmeier said, "It's like addressing the minimum wage," of putting it to a vote. "Our message is that patients shouldn't be waiting for days."

Related Slideshow: Massachusetts Emergency Care Report Card

The American College of Emergency Physicians released America's Emergency Care Environment report for 2014 in January, issuing report cards for each state in the U.S. Massachusetts ranked second overall - see the Bay State's report card grades and highlights in the slides below.