Delaware dropped 10 places overall due to worsening grades in Disaster Preparedness and Public Health and Injury Prevention. At the same time, however, Delaware continues to support a strong emergency medical system and has slightly improved its Medical Liability Environment.
Delaware continues to support one of the nation's strongest Quality and Patient Safety Environments stemming largely from the state's careful development of uniform guidelines and policies for providing emergency services. Delaware has a uniform system for pre-arrival instructions, maintains a statewide trauma registry, and has triage and destination policies in place for trauma patients, ST-elevation myocardial infarction patients (STEMI), and stroke patients.
Delaware also fares well in Access to Emergency Care, with some of the highest rates of emergency physicians (17.8 per 100,000 people) and registered nurses (1,157.3 per 100,000) in the nation. Delaware lacks access to some classes of specialty care providers, with very poor rates of access to neurosurgeons (1.0 per 100,000 people) and ear, nose, and throat specialists (2.2 per 100,000 people), but other measures are more favorable. The state ranks fourth in the country for a child's ability to see a provider when needed (97.4%) and has a relatively low percentage of people with an unmet need for substance abuse treatment (7.8%).
Indicator changes in the Disaster Preparedness category may have played some role in Delaware's grade falling precipitously since 2009, but the state ranks poorly compared to other states. Delaware has not developed mutual aid agreements with behavioral health providers to provide care during a disaster or incorporated mental health patients or patients on psychotropic medication into its medical response plan. It lacks the infrastructure to absorb a potential influx of emergency patients, with no burn unit beds and no verified burn centers, few intensive care unit beds (256.2 beds per 1 million people), and a low bed surge capacity (378.4 per 1 million). However, a state preparedness program is coordinating with hospitals in an effort to expand surge capacity and to provide burn and other specialized care. Additional funding and training is also being provided to help address the need for resources to treat burn patients.
Delaware saw a sharp drop in Public Health and Injury Prevention overall, with high rates of traffic fatalities and decreasing immunization rates. Delaware has some of the highest rates of bicyclist fatalities (12.6 per 100,000 cyclists) and pedestrian fatalities (8.2 per 100,000 pedestrians) in the nation, and 44% of traffic fatalities are alcohol related. One in five adults in Delaware also reported binge drinking (20.3%). While state injury prevention initiatives have been assumed by an active coalition through the Office of EMS and injury prevention funds have increased (from $23.13 to $66.82 per 1,000 people), this funding level is still 10 times lower than the average across the states.
Delaware's health professionals continue to face a challenging Medical Liability Environment. While the state has seen a decline in the number of malpractice award payments, it has one of the highest average malpractice awards in the nation at $507,388. The state has correspondingly high average medical liability insurance premiums for primary care physicians and specialists; these are well above the national average and have increased since 2009.
Delaware must continue to support Access to Emergency Care, specifically psychiatric care. The state ranks poorly in its availability of psychiatric care beds (23.2 per 100,000), which is a 50% decrease in capacity since 2009. Emergency psychiatric care is particularly important, and Delaware must continue to explore and expand such options as telepsychiatry and the state's Crisis and Psychiatric Emergency Services program to address this critical need. Delaware also has one of the worst hospital occupancy rates in the nation and the second lowest rate of emergency departments (ED) per capita. These factors all contribute to the state having the second longest ED wait times (387 minutes from ED arrival to departure), which is an indicator of an overloaded system that often results in boarding and crowding in the ED.
Delaware should create a more favorable Medical Liability Environment by strengthening existing policies to require periodic payments and pretrial screening panels, as well as implementing a medical liability cap on non-economic damages and additional liability protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated care.
Delaware must continue to support its already strong Quality and Patient Safety Environment by funding quality improvement of the EMS system and continuing to be at the forefront of statewide innovations and policies that aim to improve the overall emergency care system. Finally, the state should consider increasing funding for Public Health and Injury Prevention efforts aimed at improving health risk behaviors, traffic safety, and childhood immunization rates.