In January, the "National Report Card on the State of Emergency Medicine" was released by the American College of Emergency Physicians. The report was designed to assess the support each state provides for emergency care.
The report is "a wake-up call for policymakers" and "underscores the challenges facing patients who need emergency care," ACEP said.
Virginia received one of the worst overall grades of any state in the country, a D+. We should all understand the statement that this makes about Virginia's emergency care system. By understanding our state's weaknesses, we hopefully will be better able to communicate our needs to our state and national policymakers.
The report emphasizes that emergency medicine systems across the U.S. are under extreme stress. According to the report, the causes of this stress include increasing visits to emergency departments, hospital closures and lack of inpatient beds, high malpractice costs, and the associated loss of specialist on-call coverage.
The Centers for Disease Control and Prevention says 2003 marked the highest number of emergency department visits in a year, with 114 million people seeking emergency care. At the same time, the number of emergency departments has decreased by 1.4 percent a year over the past
Emergency departments usually close when whole hospitals close. A majority of the
These lost beds--for admitted patients--are the main cause for emergency room overcrowding. People are held in the emergency department waiting for inpatient beds to become available. And that results in patients waiting longer for fewer available emergency department beds.
The high cost of medical liability insurance also has been cited as a clear and present danger now and for years to come. The high costs have caused emergency physicians to retire or relocate to "malpractice friendly" states. They've also led many specialty doctors to leave medicine, or to be less willing to be "on call" for emergency situations. That makes it even more difficult for hospitals to provide emergency care.
Bad news for VirginiaVirginia--along with Alabama, Arizona, Arkansas, Idaho, Indiana, New Mexico, Oklahoma, South Dakota, Utah, Washington, and Wyoming--rates among the worst states in the nation with overall grades of D+ or D.
Virginia ranked 46th for its lack of support for an emergency care system to meet the needs of its residents. This low score was largely related to its failing grade for the Medical Liability Environment.
Virginia also had low scores in the categories of Access to Emergency Care, Quality and Patient Safety, and Public Health and Injury Prevention, according to the ACEP report.
Virginia was ranked 41st in the number of emergency departments per 1 million
Virginia's overall grade was brought down by its Medical Liability Environment. The state received an "F," ranking 48th in increases in medical liability insurance rates for physicians and specialists.
On the upsideOn a better note, Virginia ranked in the middle of the states in Public Health and Injury Prevention, receiving several above-average scores, including:
Alcohol-related fatalities as a percentage of all traffic fatalities (22nd)
Fatal occupational injuries per 1 million people (21st)
Total fatalities in alcohol-related crashes per 100,000 people (13th)
Traffic fatalities per 100,000 licensed drivers (16th).
The good scores in these areas offset Virginia's below-average marks in areas associated with immunizations. Virginia also earned high rankings for its percentage of people with access to advanced life support ambulance services (11th) and for its emergency medicine residency programs (12th).
The following are recommendations exactly as they appear in this report:
"Virginia needs to increase its number of emergency departments and hospital-staffed beds. The state also needs to improve its Quality and Patient Safety and Public Health and Injury Prevention ratings by providing greater access to certain safety services such as Enhanced 911 services. State policymakers also should reinforce the importance of immunization to its residents. Virginia should enact a $250,000 cap on noneconomic damages for medical liability lawsuits."
Virginians should take a strong interest in this report. We are ranked fourth from last in the entire U.S. in our support of statewide emergency services.
There is no doubt in our busy and rapidly expanding area that you have experienced some of the issues from this report firsthand.
Please get involved in improving our emergency services by contacting your legislators and asking specifically what they are going to do to secure access to high-quality emergency care for our citizens in the future.
To read the full report, go to my.acep.org/site/PageServ
DR. JODY CRANE is an emergency room physician at Mary Washington Hospital. SARA PHILLIPPE is a pediatric nurse and administrative director for the Nursing Center of Excellence at Mary Washington Hospital. They welcome reader comments and questions. Write to them at The Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail at
Email: newsroom@freelancestar.com