Comprehensive programs in the areas of Disaster Preparedness and the Quality and Patient Safety Environment helped propel Delaware to high marks in those categories, but a paucity of medical liability reforms and troubling statistics related to infant mortality leaves the state with opportunities for improvement.
Strengths. Delaware has a number of strengths with regard to Disaster Preparedness. The state has a greater bed surge capacity than most; it is capable of surging beyond 1,156.4 beds per 1 million people within 24 hours of a disaster event. The state also supports a statewide real-time or near real-time syndromic surveillance system, as well as a surveillance system for common emergency department presentations. The state receives relatively high federal funding for disaster preparedness ($16.50 per capita) and supports a statewide “just-in-time” training system.
Delaware’s above average score in Access to Emergency Care is primarily the result of very high rankings for a few key indicators within the category, such as Medicaid reimbursement rates for office visits (154 percent of the national average, the third highest in the country). The state also has the fourth highest rate of psychiatric care beds (47.0 per 100,000 people), well above the average among the states (29.9 per 100,000).
Indicators of the Quality and Patient Safety Environment in Delaware are consistently positive, as well, with the state having the third highest rate of emergency medicine residents (42.8 per 1 million people) and the fourth highest percentage of hospitals using electronic medical records (75.0 percent compared to an average of 43.8 percent across the states).
Challenges. The Medical Liability Environment in Delaware is among the worst in the nation. Delaware has the second highest average malpractice award payment ($457,750), which is significantly more than the average across the states ($285,218). Delaware also lacks any medical liability caps on non-economic damages, additional liability protections for EMTALA-mandated emergency care, and expert witness rules requiring the witness to be of the same specialty as the defendant.
Delaware has significant room for improvement in Public Health and Injury Prevention. The state ranked 46th in the country in infant mortality, with a rate of 9.0 deaths per 1,000 live births. The state also has a disproportionately high percentage of adults who are binge drinkers (19.0 percent) compared to the nation (15.4 percent).
Recommendations. Despite Delaware’s relatively high score with regard to Access to Emergency Care, there are strong warning signs that the state may be experiencing significant issues related to access. Emergency physicians in the state report that emergency department and hospital crowding has increasingly become a barrier to accessing quality care. In order to help alleviate crowding, Delaware should address its high hospital occupancy rate: 85.3 percent of staffed beds are occupied on an average day, the highest of any state. The state also lacks any accredited chest pain centers and has a low rate of emergency departments (7.0 per 1 million people), which may contribute to crowding and related issues.
Additionally, emergency physicians report difficulties in getting specialists to provide on-call services to the emergency department. Delaware could try to alleviate that problem by enacting special liability protections for EMTALA-mandated emergency care. This would be one step among several that the state should take to reform a medical liability system that is in desperate need of improvement. Other actions the state should consider include enacting a cap on non-economic damages and strengthening expert witness rules.
To improve upon Public Health and Injury Prevention, the state should enact legislation requiring all motorcycle riders to wear helmets and implement new programs designed to reduce the high level of binge drinking. Delaware residents would also benefit from programs intended to address the problem of infant mortality.