Low numbers of uninsured residents and substantial hospital capacity to deal with disasters are among the highlights of Ohio’s emergency care environment. However, opportunities for improvement abound in all five categories.
Strengths. Ohio has a number of characteristics that contribute to the state’s above average grade in Access to Emergency Care. The state ranks fourth for its low rate of uninsured children (5.7 percent), which is less than half the national rate. Similarly, only 11.5 percent of adults in Ohio lack insurance, compared with 17.2 percent nationally. More than 96 percent of Ohio’s population is within 60 minutes of a Level I or II trauma center.
Ohio has instituted some important medical liability reforms, including case certification by an expert witness and requiring witnesses to be of the same specialty as the defendant. In addition, Ohio is one of four states to require or provide for expert witnesses to be licensed to practice medicine in the state, which allows for state oversight of inappropriate expert witness testimony.
While Ohio did not fare well overall with regard to Disaster Preparedness, the state has substantial hospital capacity to deal with disaster events. Ohio is among the top 10 states with regard to verified burn centers (0.4 per 1 million people), burn unit beds (10.4 per 1 million), and ICU beds (375.5 per 1 million). Ohio has also established a medical reserve corps (a close analogue of the ESAR-VHP program) in 82 of its 88 counties. In addition, while the data reported indicate that Ohio’s liability protections for health care workers during a disaster event are not clearly defined, the state has mandated that medical volunteers registered in the state database are guaranteed additional liability protections.
Challenges. A number of health risk factors contribute to Ohio’s below-average grade in Public Health and Injury Prevention. Ohio has a high percentage of adults who are obese (28.4 percent), as well as a significant number of current smokers (22.4 percent of adults). The state also has the ninth highest infant mortality rate (8.3 deaths per 1,000 live births), well above the national rate of 6.9 per 1,000 live births.
Despite Ohio’s above-average grade for the Quality and Patient Safety Environment, the state is still lacking in some areas. For instance, the state does not have a uniform system for providing pre-arrival instructions and lacks a PCI network or STEMI system of care.
Disaster Preparedness poses some problems for the state, as well. While the state developed an all-hazards medical response plan, it lacks a written plan specifically for special needs patients. In addition, the state does not have a plan for the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during a disaster event. Ohio also lacks patient and victim tracking systems, but to its credit has been investigating potential patient tracking systems through a patient tracking task force.
Recommendations. While Ohio fared well with respect to the number of specialists in the workforce, emergency physicians in the state have noted a shortage of on-call specialists. Increasing Medicaid reimbursements for emergency care-related services and providing limited immunity from liability for all EMTALA-mandated care would be significant steps in encouraging specialists to provide on-call emergency care.
The state also might consider strengthening the existing medical liability reforms to alleviate physicians’ concerns with seeing patients considered to be a high liability risk. Ohio could reduce the medical liability cap on non-economic damages to the recommended $250,000 cap. In addition, the state could institute mandatory pretrial screening panels and admit their findings as evidence.
Emergency physicians in the state also report significant problems with psychiatric patients being boarded in emergency departments while waiting to see a psychiatrist or be admitted to a hospital psychiatric unit. Addressing the state’s relatively low number of psychiatric care beds (23.0 per 100,000 people) and shortage of mental health providers (21.1 full-time equivalents needed for underserved populations), may be the first steps in alleviating these problems.