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NC grade for supporting emergency medicine rises, but just to a C

RALEIGH North Carolina earned a C in a state-by-state report card on the nation’s emergency care environment released last week by the American College of Emergency Physicians, and it rated particularly poorly in access to emergency care.

The report cited reasons including too few emergency departments and not enough staffed in-patient hospital beds for giving a D grade in access to emergency care, and several emergency room physicians from across the state agreed.

One measure cited in the report is the 312 minutes that it takes, on average, for a patient who comes in first to the emergency room to be given a bed elsewhere and moved out of the emergency department. That’s an unusually lengthy wait and means that emergency rooms can get clogged with patients waiting to be moved elsewhere.

Often that’s because there is a shortage of beds and a high occupancy rate in the state’s hospitals, said Dr. Greg Cannon of Wake Emergency Physicians in Raleigh.

“That means they’re taking up a bed in the emergency department, and meanwhile more patients are still coming in, and it’s difficult to take care of those patients and you’re putting them in hallways and so forth, because beds are already occupied,” he said. “It’s a big problem in many states, and it’s certainly a problem in this state, and something we deal with every day in a lot of the emergency departments of the state.”

The report cards, which were last issued in 2009, aren’t meant to reflect on how well or poorly patients are treated in local emergency rooms, but rather the quality of support in the state, via its policies, for emergency medicine.

The state’s overall grade was a slight improvement from that of five years ago. That resulted in a sharp jump in its rankings against other states, from 32nd to a tie for 13th in the nation. Most of that improvement in ranking was based on a leap from an F to a C in the report card’s ranking for medical liability. In 2011, state lawmakers made it harder to sue for medical malpractice and placed a $500,000 cap on non-economic damages for medical liability awards.

A’s were hard to come by. The nation as a whole slid from a C- in 2009 to a D+.

There are several areas where state officials could help North Carolina improve its grade, said several doctors, including encouraging more physicians to accept Medicaid and Medicare, protecting hospitals that may be at risk of closing, reversing the slide in the number of beds for psychiatric care and making sure more hospital staff are properly trained for handling major disasters. Only about a third of the registered nurses in North Carolina have been trained in emergency preparedness, compared with about 40 percent nationally.

“Right now, the number of physicians who accept Medicare is only 2.5 per 100 Medicare beneficiaries,” said Dr. Matt Sullivan, an emergency physician with Carolinas Medical Center in Charlotte. “That’s abysmally low, and if patients can’t get in to see their primary care physicians, particularly as our population ages, it’s going to overwhelm our emergency safety net.

“And from a safety perspective, the state is going to have to address mental health. The number of mental health beds has dropped drastically, and unfortunately it means that the dominant care for psychiatric patients falls to emergency departments with no place to put them.”

The bright spot in the report card was in the state’s environment for quality and patient safety. North Carolina got an A- and was ranked fourth-best in the nation. That grade was bolstered in part by an effective program for monitoring prescription drugs and by the fact 97 percent of the state’s hospitals now have electronic records.

“Despite the fact that there is not a lot of state support for some of the issues the report card talks about, our physicians and our nurses and providers are providing high quality care,” Sullivan said. “So, we have the right people around the table. We just need the right support.”

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