Do Washington state residents have some of the worst access to emergency medical care in all of America? That’s what a reputable organization would have you believe. The American College of Emergency Physicians issued what they call a “report card” on the 50 states. They rank Washington at the very bottom when it comes to availability of hospital beds and psychiatric beds, and near the bottom in the availability of registered nurses.
But, the state Department of Health has no evidence of such a severe shortage. Spokesman Donn Moyer asked the various data-crunchers within the agency, and they concluded, “This isn’t how we would quantify access to care.” He says they can’t understand why the Emergency Physicians would measure hospital beds “per capita,” because that’s not a method that’s typically used in the world of public health.
What does this mean?
(a) there’s a hidden crisis brewing in Washington, unseen by our officials, with people getting turned away in growing numbers as they seek hospital care
(b) having fewer hospital beds in your state does not automatically translate into lack of access to care by people who live in that state
(c) an interest group has created a report that – surprise – serves the interest of its members (by advocating for more spending on hospitals and medical staff)
I would go with both (b) and (c). To believe (a), you’d have to think everyone at hospitals and in the emergency medical system is keeping quiet about a major problem, which is worse here than the rest of the country. And, they only decide to speak up when ACEP releases its bi-annual report.
Do “diversions” happen, when an Emergency Room is full, and a patient is sent to an E.R. that’s not necessarily the closest? Yes, but that also might be a sign that we’re using the medical system efficiently. What do you think?
Science and Wonder 
Regarding “beds per capita” – measuring an absolute number of hospital beds in a state would give better grades to larger states that have more hospitals and more beds. Using that criterion alone, Washington would be better than, say, Rhode Island or Wyoming simply because its population is greater than those states. By making available beds a function of the number of people in a state, it evens out the population disparity.
Interesting that you and the DOH wouldn’t quantify “access to health” in the manner used in the report card, but you fail to mention how you think it should be quantified.
As for your “hidden crisis” conspiracy theory, it isn’t so hidden. You need to read more medical blogs.
It is clear that the author does not “get it”. Not surprisingly, how could he when he does not see what occurs each day in ED across the state of Washington. I would encourage him visit many EDs on a busy week end when 18 or more patients may be stacked up in hallways, patients may be held for days or even in some cases weeks to find a psychiatric bed, and patients will wait hours to be evaluated by a physician. Hey Keith, get a basis in reality before you comment on an effort by a group of physicians to at least draw some attention to a significant social problem. Have you even been in a busy ED lately? By the way, do you have better data? I know many emergency physicians and nurses and I can assure you there is a shortage of qualitifed emergency health care professionals in this state, there is a shortage of beds in this state and not surprisingly it is difficult to recruit health professionals to this state.
Thanks for commenting. This could be a long discussion.
I think calling attention to over-crowding in emergency rooms is a fine idea, and it’s a story that’s been told many times, on the radio, on TV and in newspapers. The causes of and solutions for the crowding are not so obvious. Does it mean Washington should have more inpatient hospital beds? That’s the category where the emergency physicians’ report gives Washington the lowest score in the nation, and it’s weighted to give Washingotn a failing grade in “access.”
From what I’ve heard and read, having more nurses would solve a lot of problems, because without nurses, available beds can’t be used. But the nursing shortage is not peculiar to Washington state.
Re. the per capita comment, the problem is not using per capita instead of raw numbers. The problem is taking a state-wide aggregate of hospital beds, dividing it by the state’s population, and presenting that as meaningful or relevant. Those who study access and the need for facilities look at a lot of data, but not this number.
I’m not publishing a report on hospital beds. But there is one agency that by law has to consider such questions — because this state requires a “certificate of need” in order to get permission to build new hospitals. That agency is the Washington Department of Health. The man in charge of these reviews, Steve Saxe, looked at the numbers from ACEP, and he said he had no way to evaluate whether they are meaningful. If you’re interested in the details of how the state does evaluate capacity (which is done by geographic regions, not statewide), then you’re in for a long study-session. But, three brand new hospitals have been approved in recent years — in Vancouver, Gig Harbor, and Issaquah.
I guess the root of my complaint is, doctors (to their credit) typically want decisions to be based on scientifically sound data. The ACEP report is a mash-up of unrelated data, which is really nothing more than an editorial. Lots of groups also issue “Report Cards” to get attention, so ACEP is jumping in the same category as all the other activists.
– Keith