Category Grades
10C+ 20C-
Access to Emergency Care:
8B- 7C+
Quality/Patient Safety:
9A- 7B+
Medical Liability:
45F 34D
Public Health/ Injury Prevention:
26C- 36D-
Disaster Preparedness:
11A- 38F

Delaware dropped 10 places overall due to worsening grades in Disaster Preparedness and Public Health and Injury Prevention. At the same time, however, Delaware continues to support a strong emergency medical system and has slightly improved its Medical Liability Environment.

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Delaware continues to support one of the nation's strongest Quality and Patient Safety Environments stemming largely from the state's careful development of uniform guidelines and policies for providing emergency services. Delaware has a uniform system for pre-arrival instructions, maintains a statewide trauma registry, and has triage and destination policies in place for trauma patients, ST-elevation myocardial infarction patients (STEMI), and stroke patients.

Delaware also fares well in Access to Emergency Care, with some of the highest rates of emergency physicians (17.8 per 100,000 people) and registered nurses (1,157.3 per 100,000) in the nation. Delaware lacks access to some classes of specialty care providers, with very poor rates of access to neurosurgeons (1.0 per 100,000 people) and ear, nose, and throat specialists (2.2 per 100,000 people), but other measures are more favorable. The state ranks fourth in the country for a child's ability to see a provider when needed (97.4%) and has a relatively low percentage of people with an unmet need for substance abuse treatment (7.8%).


Indicator changes in the Disaster Preparedness category may have played some role in Delaware's grade falling precipitously since 2009, but the state ranks poorly compared to other states. Delaware has not developed mutual aid agreements with behavioral health providers to provide care during a disaster or incorporated mental health patients or patients on psychotropic medication into its medical response plan. It lacks the infrastructure to absorb a potential influx of emergency patients, with no burn unit beds and no verified burn centers, few intensive care unit beds (256.2 beds per 1 million people), and a low bed surge capacity (378.4 per 1 million). However, a state preparedness program is coordinating with hospitals in an effort to expand surge capacity and to provide burn and other specialized care. Additional funding and training is also being provided to help address the need for resources to treat burn patients.

Delaware saw a sharp drop in Public Health and Injury Prevention overall, with high rates of traffic fatalities and decreasing immunization rates. Delaware has some of the highest rates of bicyclist fatalities (12.6 per 100,000 cyclists) and pedestrian fatalities (8.2 per 100,000 pedestrians) in the nation, and 44% of traffic fatalities are alcohol related. One in five adults in Delaware also reported binge drinking (20.3%). While state injury prevention initiatives have been assumed by an active coalition through the Office of EMS and injury prevention funds have increased (from $23.13 to $66.82 per 1,000 people), this funding level is still 10 times lower than the average across the states.

Delaware's health professionals continue to face a challenging Medical Liability Environment. While the state has seen a decline in the number of malpractice award payments, it has one of the highest average malpractice awards in the nation at $507,388. The state has correspondingly high average medical liability insurance premiums for primary care physicians and specialists; these are well above the national average and have increased since 2009.


Delaware must continue to support Access to Emergency Care, specifically psychiatric care. The state ranks poorly in its availability of psychiatric care beds (23.2 per 100,000), which is a 50% decrease in capacity since 2009. Emergency psychiatric care is particularly important, and Delaware must continue to explore and expand such options as telepsychiatry and the state's Crisis and Psychiatric Emergency Services program to address this critical need. Delaware also has one of the worst hospital occupancy rates in the nation and the second lowest rate of emergency departments (ED) per capita. These factors all contribute to the state having the second longest ED wait times (387 minutes from ED arrival to departure), which is an indicator of an overloaded system that often results in boarding and crowding in the ED.

Delaware should create a more favorable Medical Liability Environment by strengthening existing policies to require periodic payments and pretrial screening panels, as well as implementing a medical liability cap on non-economic damages and additional liability protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated care.

Delaware must continue to support its already strong Quality and Patient Safety Environment by funding quality improvement of the EMS system and continuing to be at the forefront of statewide innovations and policies that aim to improve the overall emergency care system. Finally, the state should consider increasing funding for Public Health and Injury Prevention efforts aimed at improving health risk behaviors, traffic safety, and childhood immunization rates.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.0 9.9
Emergency physicians per 100,000 pop 14.7 17.8
Neurosurgeons per 100,000 pop 1.6 1.0
Orthopedists and hand surgeon specialists per 100,000 pop 8.3 8.2
Plastic surgeons per 100,000 pop 2.7 2.4
ENT specialists per 100,000 pop 3.1 2.2
Registered nurses per 100,000 pop 987.4 1,157.3
Percent of children able to see provider 97.4
Level I or II trauma centers per 1M pop 1.2 1.1
Percent of population within 60 minutes of Level I or II trauma center 93.1 100.0
Accredited chest pain centers per 1M pop 0.0 0.0
Percent of population with an unmet need for substance abuse treatment 7.7 7.8
Pediatric specialty centers per 1M pop 3.5 3.3
Medicaid fee levels for office visits as a percent of the national average 154.0 143.5
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) NR 14.5
Percent of adults with no health insurance 12.3 11.1
Percent of adults underinsured 7.9
Percent of children with no health insurance 11.7 6.4
Percent of children underinsured 18.3
Percent of adults with Medicaid 6.2 10.9
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 315.7 289.6
Hospital occupancy rate per 100 staffed beds 85.3 74.4
Psychiatric care beds per 100,000 pop 47.0 23.2
Median time from ED arrival to ED departure for admitted ED patients 387
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $16.50 $12.83
State budget line item health care surge NR
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES,YES YES
Public health and emergency physician input during an ESF-8 response NR
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO NO
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO NO
Mental health patients included in medical response plan NO
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers NONE
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing YES
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system YES NR
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 1,156.4 378.4
ICU beds per 1M pop 300.2 256.2
Burn unit beds per 1M pop 0.0 0.0
Verified burn centers per 1M pop 0.0 0.0
Physicians registered in ESAR-VHP per 1M pop 32.4 38.2
Nurses registered in ESAR-VHP per 1M pop 82.1 214.8
Behavioral health professionals registered in ESAR-VHP per 1M pop 22.9
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES,YES NR
Percent of RNs that received emergency training 50.5 43.7

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 28.1 31.1
Lawyers per physician 1.0 1.1
Lawyers per emergency physician 18.9 17.5
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -2 0
Malpractice award payments per 100,000 pop 6.9 1.1
Average malpractice award payments $457,750 $507,388
National Practitioner Databank reports per 1,000 physicians 22.7 23.0
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 25.3 26.6
Average medical liability insurance premiums for primary care physicians $13,787 $15,760
Average medical liability insurance premiums for specialists $55,543 $62,902
Presence of pretrial screening panels VOLUNTARY VOLUNTARY
Pretrial screening panel's findings admissible as evidence YES YES
Periodic payments are: required, granted upon request, at court's discretion COURT'S DESCRETION COURT'S DESCRETION
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished NO NO
Collateral Source Rule/Provides for Awards to be Offset YES, NO OFFSET
State provides for case certification YES YES
Expert witness required to be of the same specialty as the defendant NO NO
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 12.6
Pedestrian fatalities per 100,000 pedestrians 8.2
Percent of traffic fatalities alcohol-related 39.0 44.0
Percent of front occupants using restraints 86.6 90.3
Child safety seat/seat belt legislation - score out of a possible 10 points 8 8
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 4
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 84.2 72.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 70.3 63.4
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 65.6 69.2
Fatal occupational injuries per 1M workers 29.5 20.3
Homicides and suicides (non-motor vehicle)(per 100,000) 16.4 18.4
Unintentional fall-related fatal injuries (per 100,000) 5.7 5.6
Fire/burn related fatal injuries (per 100,000) 1.3 0.7
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 NR
Rate of unintentional poisoning-related deaths (per 100,000) 13.9
Total injury prevention funds per 1,000 persons $23.13 $66.82
Dedicated child injury prevention funding NO
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 9.0 7.7
Percentage of adults who binge drink 19.0 20.3
Percentage of adults who currently smoke 21.7 21.8
Percentage of adult population who are obese (BMI > 30.0) 26.0 28.8
Percentage of children who are obese 16.9
Cardiovascular disease disparity ratio 3.8
HIV diagnosis disparity ratio 7.6
Infant mortality disparity ratio 2.8

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES NO
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 42.8 39.3
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 100.0 100.0
State has a uniform system for providing pre-arrival instructions YES YES
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 3
% of hospitals with computerized practitioner order entry 25.0 100.0
% of hospitals with electronic medical records 75.0 100.0
% of patients with AMI given PCI within 90 minutes of arrival 61 94
Median time to transfer to another facility for acute coronary intervention 67
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 58.3
% of hospitals with or planning to develop a diversity strategy or plan 41.7

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