South Dakota has improved slightly in a number of categories since 2009 but continues to struggle to recruit an adequate health care workforce despite recent efforts to draw providers to rural areas of the state. The state has made little improvement in its Quality and Patient Safety Environment.
While more work can be done, South Dakota has made admirable strides in Disaster Preparedness. The state has high per capita rates of physicians and nurses registered in the Emergency System for Advance Registration of Volunteer Health Professionals, and a relatively high proportion of registered nurses have received Disaster Preparedness training (42.0%). South Dakota also addresses the needs of mental health patients in its medical response plan and has mutual aid agreements in place with behavioral health providers for services during a disaster.
Although South Dakota scored poorly in Access to Emergency Care, emergency physicians in the state report a recent significant step forward in better meeting the needs of the state's rural population through the implementation of emergency medicine telemedicine programs. These programs allow small rural emergency departments (ED) to contact board-certified emergency physicians for immediate consultation and management services.
Little has changed in South Dakota's Medical Liability Environment. While the state lacks expert witness rules, it has a relatively large number of insurers writing medical liability policies (25.6 per 1,000 physicians) and the third lowest medical liability insurance premiums for primary care providers and specialists ($4,478 and $17,428, respectively). The state has maintained its medical liability cap on non-economic damages but has not abolished joint and several liability.
While making a few notable improvements since the 2009 Report Card, South Dakota faces a number of challenges to improving its Quality and Patient Safety Environment. The state has not provided funding for quality improvement of the emergency medical services (EMS) system or an EMS medical director. South Dakota also lacks a uniform system for providing pre-arrival instructions, which could be important in helping to save lives in a rural state, where EMS providers may have long response times. While South Dakota has implemented a statewide trauma registry and has worked to develop stroke and ST-elevation myocardial infarction (STEMI) systems of care, it still lacks destination policies for trauma and STEMI patients.
Access to Emergency Care in South Dakota has substantially worsened, with low levels of numerous types of providers and concerns regarding behavioral health care. The state ranks among the bottom 10 in per capita rates of emergency physicians and plastic surgeons and faces substantial unmet needs for both primary care and mental health providers. The number of psychiatric care beds in the state has plummeted since 2009, from 25.7 to 15.6 per 100,000 people, and the state has a large proportion of adults with an unmet need for substance abuse treatment (10.2%). Additionally, while South Dakota has the highest per capita rate of EDs and the lowest ED wait times in the nation, only 35.9% of the population is within 60 minutes of a level I or II trauma center.
Public Health and Injury Prevention continues to be a concern when considering South Dakota's limited access to primary and emergency care. Immunization rates for children and pneumococcal vaccinations for older adults are among the worst in the nation. South Dakota also has a high rate of traffic fatalities (15.7 per 100,000 people) and the weakest child safety seat and seatbelt laws in the country, resulting in the second lowest seatbelt use rate (73.4%). The state has failed to pass legislation banning handheld cellphone use and texting for all drivers.
South Dakota must continue to work toward increasing the health care workforce to meet the needs of its aging population. Addressing the need for primary care and mental health care providers across the state should be a priority in improving care for all. Although expansion of new emergency medicine telemedicine programs can be instrumental in improving access to quality care, South Dakota should continue to invest in health care education and recruitment programs to draw more providers to rural areas. The state should also address other concerns regarding preventable illness and death, such as improving vaccination rates through outreach and education.
Traffic fatalities are a major cause of preventable death and a driver of emergency care needs in South Dakota. The state should explore numerous avenues to address this issue, including strong seatbelt and child safety seat use laws, a requirement that all motorcycle riders wear helmets, and distracted-driving laws for all drivers.
Finally, South Dakota should build on the systems and infrastructure it has created for Disaster Preparedness to improve the Quality and Patient Safety Environment. Instituting a uniform system for pre-arrival instructions could improve emergency response outcomes, as could a destination policy for trauma patients.