While Hawaii can boast of a high rate of seat belt use and a low percentage of uninsured residents, the state’s emergency care environment is still hampered by a lack of quality initiatives and hospital capacity concerns.
Strengths. Hawaii’s high mark in Public Health and Injury Prevention is influenced by the state’s high percentage of front occupants using seat belts (97.6 percent) and low rate of unintentional fire- or burn-related fatal injuries (0.3 per 100,000 people). For both of these indicators, Hawaii ranks first among the states. The state also has the second highest rate of adults aged 65 years and older who have received the flu vaccine in the past 12 months (75.7 percent) and the third lowest rates of homicides and suicides and unintentional firearm-related fatal injuries. Compared to other states, Hawaii has the fourth lowest percentage of adults who are obese. However, at 20.6 percent, there is still room for improvement.
Hawaii has the 16th lowest average malpractice award payment and 2nd lowest number of National Practitioner Databank reports per 1,000 physicians, helping to make the state’s Medical Liability Environment more favorable than most. The state has also abolished joint and several liability and made pretrial screening panels mandatory.
Hawaii has taken some strides to incorporate important Disaster Preparedness planning into its state operations and to implement policies that enhance its ability to respond to a disaster. For example, Hawaii has a real-time notification system in place to notify identified health care providers of an event, as well as statewide “just-in-time” training systems, a medical communication system with one layer of redundancy, and statewide patient and victim tracking systems. Furthermore, the state requires all EMS personnel and essential hospital personnel to be trained in disaster management and response to bio- and chemical terrorism. The state is also one of only two to provide criminal liability protections to health care workers during a disaster.
Hawaii fares better than most states with regard to Access to Emergency Care, which is influenced by the state’s relatively low percentage of adults with no health insurance (9.6 percent) or with an unmet need for substance abuse treatment (7.2 percent), as well as a relatively small shortage of mental health and primary care providers.
Challenges. Hawaii lacks requirements for adverse event and hospital-based infections reporting, which may contribute to its below-average grade in the Quality and Patient Safety Environment. Other contributing factors include the state’s lack of a uniform system for providing pre-arrival instructions and failure to maintain a statewide trauma registry.
Despite all of the strides Hawaii has made in terms of Disaster Preparedness, the state still lacks an all-hazards medical response plan and specific plans for special needs patients, to supply medications for chronic conditions, and to supply dialysis for patients in the event of a disaster. The state also has no verified burn centers and ranks poorly for the number of ICU beds (50th).
On a similar note, despite Hawaii’s fair grade in Access to Emergency Care, the state is lacking with regard to hospital capacity. The state ranks among the worst four with regard to the number of pediatric specialty centers, accredited chest pain centers, and the daily hospital occupancy rate.
Recommendations. Hawaii should make a strong effort to improve the Quality and Patient Safety Environment. In addition to establishing a statewide trauma registry, the state should continue to focus additional efforts on supporting and strengthening trauma care throughout the state.
Capacity and facility needs should also be addressed to ensure that resources are sufficient to adequately meet the needs of the population on an everyday basis and in times of disaster.
Hawaii can also take steps to further improve its Medical Liability Environment by providing additional liability protection for EMTALA-mandated emergency care and instituting expert witness rules such as case certification requirements, requiring expert witnesses to be of the same specialty as the defendant, and requiring expert witnesses to be licensed in the state.