Maryland has a statewide model of emergency care. The high grades in Quality and Patient Safety Environment, Public Health and Injury Prevention, and Disaster Preparedness reflect a relentless commitment to these areas. However, the state has not kept pace with other states regarding medical liability reform and faces some hospital capacity shortages.
Maryland has the highest Quality and Patient Safety Environment ranking in the nation. The state has enacted multiple policies and procedures to ensure that its patients receive swift and effective care, including triage and destination policies for trauma, stroke, and ST-elevation myocardial infarction (STEMI) patients. Maryland maintains a statewide trauma registry, and nearly all its hospitals have adopted computerized practitioner order entry (93.9%) and electronic medical records (95.9%). To ensure that the state's diverse population receives quality care, more than half its hospitals have or are planning for a diversity strategy, and 60.9% collect data on patient race and ethnicity and primary language. Finally, Maryland has made a financial commitment to Quality and Patient Safety, with dedicated funds for a state emergency medical services (EMS) medical director and for quality improvement in the EMS system.
Maryland is 10th in the nation in Disaster Preparedness and has incorporated many important state-level policies and procedures. The state has developed medical response plans that address the requirements of special needs patients and patients dependent on medication. Maryland's just-in-time training systems are in place statewide, and almost 40% of the state's registered nurses have received disaster training. Maryland's statewide patient tracking system and surveillance system for common emergency department (ED) presentations help ensure that the state is able to identify and respond to evolving disasters.
Maryland also rates highly in Public Health and Injury Prevention due to strong legislation aimed at improving public health and traffic safety, such as banning all smoking in bars, restaurants, and worksites; distracted driving bans; and child safety seat and seat belt legislation. The state also benefits from low rates of unintentional injury. Maryland has the lowest rate of poisoning deaths, which include drug overdoses, in the nation.
Maryland has not, however, kept pace with developments in the Medical Liability Environment, slipping to 47th in the nation. Although the state has implemented some needed medical liability reforms, such as a cap on non-economic damages and pretrial screening panels, it has relatively high average malpractice awards ($374,121) and a high per capita number of malpractice award payments (3.4 per 100,000 people). Maryland has one of the highest average medical liability insurance premiums for specialists at $96,807, more than 1.7 times the national average, and a relatively high average medical liability insurance premium for primary care physicians ($18,089).
In Access to Emergency Care, there are signs that Maryland's emergency medicine infrastructure is strained. The state has one of the longest median ED wait times (367 minutes from ED arrival to departure for admitted patients) and a high hospital occupancy rate (74.7 per 100 staffed beds). Maryland also has few EDs per capita (8.3 per 1 million people), despite relatively high rates of emergency physicians.
Maryland would benefit most from reforms aimed at lowering the state's high medical liability insurance rates and malpractice awards. Adopting structured settlements would better match the award to the ongoing needs of the plaintiff. Collateral source rule reform would help to ensure that plaintiffs are not doubly compensated and be advantageous to the state. Strengthening the state's currently weak apology law would protect physician apologies from being admissible in liability cases.
Maryland should support efforts to increase capacity for emergency care and alleviate crowding in EDs. A failure to address this growing issue may result in loss of quality of care and poor health outcomes for patients.
Although Maryland fared well in Public Health and Injury Prevention overall, the state lags in some traffic safety indicators. Maryland must work to reduce its high proportion of traffic fatalities that are alcohol-related (40.0%) and high rates of bicyclist and pedestrian fatalities. Maryland should concentrate on ensuring the safety of all road users, educating drivers on the dangers of drinking and driving.