Mixed grades for state's emergency care

Connecticut ranked 15th overall, but some flaws cited in report

The state's performance on the 2014 American College of Emergency Physicians' state-by-state report card on emergency department care shows mixed results, with grades in categories ranging from a B+ to a D.

"Our low rates of fatal injuries and the general good health of our residents are to be commended," Dr. Jorge Otero, president of the Connecticut College of Emergency Physicians, said in a news release Thursday. "However, people are waiting almost six hours for emergency care. The best medicine in the world doesn't help you if you can't get to it in a timely manner."

Overall, Connecticut ranked 15th among the 50 states, behind North Carolina and New York. First on the list was Washington, D.C., followed by Massachusetts and Maine.

Connecticut's strongest grade, a B+ in the "Public Health and Injury Prevention" category, was achieved due to low rates of accidental firearm-related deaths, accidental poisoning deaths, fatal occupational injuries, homicides, suicides, smoking and obesity, the news release said. The state ranked eighth in that category, behind Maine.

In "Access to Emergency Care," Connecticut earned a C-, 18th nationwide. Wait times are the sixth longest in the country, due in part to having a relatively small number of emergency departments statewide. A high percentage of hospitals in Connecticut use electronic medical records, and the state has implemented a prescription drug monitoring program, which resulted in a grade of C+ for" Quality and Patient Safety Environment," placing it 18th among the 50 states.

The state ranked in the bottom half of the country for both "Disaster Preparedness," with a C-, and "Medical Liability Environment," with a D. While other states generally have upgraded and improved their ability to respond to disasters, Connecticut has not kept pace with policies and procedures to enhance its ability to respond quickly to a large-scale disaster, the report said. The 32rd place showing for Connecticut in "Medical Liability Environment" is largely due to the extremely high insurance premiums for physicians. The average premium for primary care physicians is more than $10,000 higher than the national average.

"We need significant liability protections in order to retain good physicians here and to discourage defensive medicine," Dr. Otero said. "Connecticut must invest in more hospital infrastructure to ensure that it keeps up with demand for care every day and during disasters."

The report card evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. It has 136 measures in five categories: "Access to Emergency Care" (30 percent of the grade); "Quality and Patient Safety" (20 percent); "Medical Liability Environment" (20 percent); "Public Health and Injury Prevention" (15 percent); and "Disaster Preparedness," (15 percent). While the nation overall earned a mediocre grade of C- on the Report Card issued in 2009, this year the country received a near-failing grade of D+, according to the news release.

ACEP is the national medical specialty society representing emergency medicine.

- Judy Benson

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