Washington earns the highest rank in the nation for its Quality and Patient Safety Environment and ranks among the top five in Public Health and Injury Prevention. However, some serious issues remain, including the state’s worst-in-the-nation rankings for per capita rates of inpatient and psychiatric care beds.
Strengths. Washington leads the nation with regard to the Quality and Patient Safety Environment. The state has a uniform system for providing pre-arrival instructions, and every county in the state has Enhanced 911 capability. The state also has shown commitment to quality and patient safety through funding for quality improvement within the EMS system, as well as supporting a funded state EMS medical director position. Washington is implementing a stroke system of care and maintains a statewide trauma registry.
Washington ranks fourth in Public Health and Injury Prevention, showing a strong performance in a number of areas. The state has a relatively low rate of traffic fatalities (9.9 per 100,000 people), combined with a high rate of seat belt use (96.4 percent of front occupants). In addition, the state has the second lowest infant mortality rate in the nation (5.1 deaths per 1,000 live births), as well as the fifth lowest percentage of adult smokers (17.1 percent).
Challenges. Access to Emergency Care should be a major concern for Washington, given the state’s poor performance in this category. The state ranks 51st for rates of staffed inpatient and psychiatric care beds (208.7 and 8.2 per 100,000 people, respectively). In addition, the state has a great need for primary care and mental health providers: 144.0 primary care and 40.5 mental health full-time equivalent providers are needed to serve the state’s growing population. Finally, the state has only 10.0 emergency departments per 1 million people, which is nearly half the average across the states.
While the state’s average malpractice award is slightly less than the average state, Washington performs poorly with regard to the Medical Liability Environment for having failed to implement a number of reforms. The state is one of only 20 that have not instituted a medical liability cap on non-economic damages. In addition, the state has only partially abolished joint and several liability and does not require expert witnesses to be of the same specialty as the defendant.
In some respects, the state appears to be ill-prepared for a major disaster event. Washington receives a relatively low level of federal funding for disaster preparedness ($7.09 per capita) and lacks victim and patient tracking systems, as well as a statewide real-time or near real-time syndromic surveillance system. The state also has the lowest rate of ICU beds available to serve its population during a crisis (184.5 per 1 million people). Washington also is one of only 18 states without a requirement that EMS personnel and essential hospital personnel be trained in disaster management and response to bio- and chemical terrorism.
Recommendations. Washington needs to address critical shortages of staffed inpatient beds and psychiatric care beds, as well as the shortage of health care professionals to improve Access to Emergency Care throughout the state.
A more favorable Medical Liability Environment may help the state address its serious shortfall of physicians. Liability reforms could include a cap on non-economic damages, pretrial screening panels, expert witness rules requiring the witness to be of the same specialty as the defendant, and a provision for witnesses to be licensed to practice medicine in the state. To help encourage specialists to provide needed on-call services for emergency patients, the state could also consider special liability protections for providers of EMTALA-mandated emergency care.
The state also could improve its Disaster Preparedness grade by increasing bed surge capacity from 188.8 per 1 million people to more closely align with the average across the states: 673.4 per 1 million. Similarly, Washington also would benefit from a greater number of ICU beds in case of a disaster event, as noted above. The state, which is capable of verifying the credentials of volunteer health professionals and assigning them to one of four levels within the Emergency System for Advance Registration of Volunteer Health Professionals, could benefit greatly from increasing registration among nurses and physicians.