Hawaii's C-minus grade on emergency care environment should not totally reflect on Maui County and Maui Memorial Medical Center, which is "always striving to improve" its services by investing in emergency preparedness, the hospital's top official said last week.
Maui Memorial Chief Executive Officer Wes Lo was responding to the 2014 American College of Emergency Physicians' state-by-state report card released last week on America's emergency care environment. Hawaii was ranked 24th in the nation.
Overall, the nation received a D-plus for emergency care environment. The top rank went to Washington, D.C., and Wyoming was last on the list.
"It is important to note that the report was for Hawaii as a state and not Maui alone. (Maui Memorial Medical Center) is always striving to improve our services through investing in areas such as emergency preparedness," Lo said in an email.
He also pointed to Maui Memorial being designated as a Level 3 Trauma Center last year.
There are three levels of trauma centers - Level 1 being the highest and Level 3 the lowest. There are no Level 1 trauma centers in Hawaii.
The Queen's Medical Center on Oahu has the highest trauma center rating in the state at Level 2, state officials have said.
Lo was asked to comment only on Hawaii's overall grade.
Maui's lone acute-care hospital remains focused on improving its ability to mobilize resources during critical situations, he said. The hospital expanded its Emergency Department in 2008 and is in the planning phases of another expansion of the department.
There are plans for development of a second acute-care hospital, the West Maui Hospital and Medical Center, which could open in about two years in Kaanapali, said officials with developer Newport Hospital Corp.
Toby Clairmont, director of emergency services for Healthcare Association of Hawaii, of which MMMC is a member, pointed out that Hawaii ranks "in the middle" and "slightly better than the national average."
HAH is a nonprofit representing the hospitals and acute-care hospitals in the state.
In an email, Clairmont said the scorecard fails to take into account "important pieces of information" in the two worst-ranking areas in Hawaii. Those areas were access to emergency care and disaster preparedness.
According to its website, 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), Hawaii received an F; quality of patient safety (20 percent), Hawaii received a B-minus; medical liability environment (20 percent), Hawaii received a D-plus; public health and injury prevention (15 percent), Hawaii received an A; and disaster preparedness (15 percent), Hawaii received an F.
Dr. Jay Ishida, president of the Hawaii Chapter of ACEP, said in a release that "the admirable commitment that Hawaii's state government shows to public health needs to be shown in other areas that affect emergency patients. Our ability to respond to both everyday emergencies and potential disasters or mass casualty events is seriously compromised by hospital shortages and lack of burn units and ICU beds."
According to the report card, access to emergency care in Hawaii has been severely hampered by the closure of two hospitals in 2011. (Hawaii Medical Centers shut down two hospitals, both on Oahu.) The state has a sufficient number of emergency physicians but few emergency departments, and hospitals are nearly at capacity. Patients wait on average more than five hours in the Emergency Department of Hawaii facilities.
The problems with access to care hamper Hawaii's ability to respond to disasters, which is troubling in a state surrounding by water. According to the report card, increasing the availability of medical facilities, ICU beds, burn beds, emergency departments and inpatient beds would go a long way toward improving the state's access to emergency medical care and increase its ability to respond to large-scale disasters and mass casualty events.
Hawaii ranked second in the nation with an A for public health and injury prevention because of low rates of chronic disease and fatal injuries. The state has high per capita funding dedicated to injury prevention and some of the lowest rates of obesity in the nation.
For medical liability environment, Hawaii received a D-plus because of the paucity of liability protections for the state's health care workforce, the report said. The state could improve by implementing expert witness rules requiring case certification and by instituting liability protections for care provided in the Emergency Department.
Hawaii's B-minus in quality and patient safety environment reflects the state's strong commitment to quality improvement and system oversight, the report said. The state has a uniform system for providing pre-arrival instructions, a statewide trauma registry and a funded state emergency medical services director.
Clairmont said the report did not take into account the opening this spring of the The Queen's Medical Center-West Oahu, now with 80 beds. Plans call for expanding its emergency room capacity from 10 to 23 patients. This could have helped boost Hawaii's grade, according to Clairmont.
Also, in the disaster preparedness category, Clairmont said the methodology didn't take into account preparedness efforts by HAH emergency services and its 130 coalition members throughout the state.
For example, Hawaii has a core of 181 trained medical professionals (Hawaii Disaster Medical Assistance Team and Kalawoa Rescue) ready to respond locally or nationally to disasters.
Also part of the disaster readiness in Hawaii is a 150-bed portable disaster hospital system that can be deployed and set up within four hours to augment hospitals or care for casualties at disaster scenes anywhere in the state, according to the HAH.
For more information, see www.emreportcard.org.
* Melissa Tanji can be reached at firstname.lastname@example.org.