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POSTED: Tuesday, December 09, 2008

Hawaii is among the best states for health and emergency care, according to a report released today by the American College of Emergency Physicians.

                                                                                                                                                                                                                           

Category	State rank	Grade
Flu vaccination rate	1	A
Health and injury prevention	5	A-
Disaster preparedness	24	C+
Access to ER care	22	C
Patient safety environment	39	D-

It ranked 16th among states with an overall C-plus on a National Report Card on the State of Emergency Medicine and received the highest marks in several major areas.

An A-minus score gave Hawaii a fifth-place ranking for public health and injury prevention. It was first for its flu vaccination rate and nearly 100 percent for buckling up seat belts. It also had low rates for unintentional fire and fatal injuries related to burns.

Dr. Linda Rosen, chief of the state health Department's Emergency Medical Services and Injury Prevention Systems Branch, said she was happy because those programs are in her branch. “;I think we have a model in Hawaii because we integrate injury prevention and emergency services,”; she said.

Among the state's weaknesses, the report cited a failure to maintain a statewide trauma registry, but Rosen said a registry is being developed with cigarette tax funds allocated by the Legislature.

The database of hospitalized patients with serious injuries will allow the state to better understand the patterns of injury and quality of care provided, she said.

  Other categories in the report card and Hawaii's grades were: Access to Emergency Care, 22nd in the nation with a C; Quality and Patient Safety Environment, 39th with a D-plus; Medical Liability Environment, 16th, C-plus; and Disaster Preparedness, 24th or C-plus.

Hawaii's overall grade was a little better than the national grade of C-minus. Massachusetts received a B, the highest overall grade, and Arkansas was last (51st) with a D-minus.

Dr. Nick Jouriles, president of the American College of Emergency Physicians, stressed in a news release that an increasing number of people will need emergency care because of “;the weakened economy combined with a failing health care system.”;

“;We are urging President-elect Obama and the new Congress to strengthen emergency departments because they are a heath care safety net for us all,”; he said.

  These were among improvements recommended in the report for Hawaii: Increase the number of intensive care beds, pediatric specialty centers, chest pain and burn centers; develop plans to help special-needs patients in a disaster and provide medications and dialysis to those chronically ill; provide more liability protection for emergency care workers; enact requirements to report adverse events and hospital-based infections; and implement a uniform system for providing pre-arrival instructions for ambulances.

Regarding the last recommendation, Rosen said dispatchers give instructions when someone calls 911 for an ambulance. “;I think the key word probably is 'uniform,'”; she said, explaining counties have different systems.

Dr. Andy Po-Chang Lee, president of the American College of Emergency Physicians' Hawaii Chapter, said in a news release that without the recommended systems, “;the state of emergency care in Hawaii is vulnerable, leaving our patients vulnerable. It's cause for serious concern.”;

  Cathy Young, vice president for patient care, cardiac services, medicine and geriatrics at the Queen's Medical Center, the state's designated trauma center, said it has worked with EMS to put a wireless electrocardiogram machine in all ambulances on Oahu and train EMS staff. Queen's has paid for the entire system, she said.

A team is assembled to treat patients in the cardiac catheterization lab as soon as an ambulance arrives, and the mortality rate on Oahu for acute heart attacks has dropped to about 3 percent from “;double digits five years ago,”; she said. “;It is very positive for the state.”;

No patient is turned away from emergency care, and Queen's' emergency department has about 50,000 visits annually, said Cindy Kamikawa, vice president of nursing and chief nursing officer.

“;I think our commitment to quality in the organization is in all the different areas we do,”; she said, regarding the state's low ranking for “;quality of patient safety environment.”; Quality indicators are carefully monitored, she said.

The hospital provides information about different health aspects and issues and reports “;key measures”; on a public Web site, healthgrades.com, she pointed out. “;We have made significant improvements in them over the years.”;

The report card notes significant advances in Hawaii in disaster preparedness, including a real-time system to notify specific health care providers of events, statewide “;just-in-time”; training systems and patient and victim tracking systems.

 

               

     

 

 

CORRECTION         The Queen's Medical Center's cardiac care includes a team that is assembled to treat patients in the cardiac catheterization lab as soon as an ambulance arrives. This article originally referred to it as a cardiac cauterization lab.