Substantial challenges face South Dakota’s emergency care environment, as the state ranked last in the nation for its Quality and Patient Safety Environment and 48th in Public Health and Injury Prevention. The state’s strongest performance was in Access to Emergency Care.
Strengths. South Dakota’s average medical liability insurance premiums are among the lowest in the nation. The state also has the sixth lowest average malpractice award payment ($182,638), which is more than $100,000 less than the average state. South Dakota also has instituted a medical liability cap on non-economic damages and allows for periodic payments of malpractice awards.
South Dakota has significant infrastructure for providing emergency care. The state has relatively high rates of emergency departments and Level I or II trauma centers per capita. With regard to Disaster Preparedness indicators, the state has the third highest bed surge capacity in the nation and a relatively high number of ICU beds (375.4 per 1 million people) compared with the average across the states (299.0 per 1 million people).
Challenges. The Quality and Patient Safety Environment poses numerous challenges to the state. South Dakota lacks funding for quality improvement within the EMS system, as well as a funded state EMS medical director position. In addition, there is no uniform system in place for providing pre-arrival instructions. South Dakota also lacks a statewide trauma registry. Finally, the state ranks among the bottom five with regard to hospitals’ use of computerized practitioner order entry and electronic medical records.
The state’s failing grade in Public Health and Injury Prevention points to significant problems. South Dakota ranked among the six worst states with regard to traffic fatalities, fatal occupational injuries, and fatal fall-related unintentional injuries. The state also has a low rate of seat belt use and a higher than average percentage of adults reporting binge drinking.
In Disaster Preparedness, South Dakota fared poorly for numerous volunteer preparedness indicators. While the state has the ability to verify credentials of volunteer health professionals in a state-based Emergency System for Advance Registration of Volunteer Health Professionals program, South Dakota reported having no nurses or physicians registered in the system. In addition, the state does not require EMS or essential hospital personnel to be trained in disaster management and response to bio- and chemical terrorism.
South Dakota faces a number of challenges regarding Access to Emergency Care. Despite having the highest number of emergency departments per capita, the state has the lowest rate of emergency physicians. Similarly, despite a relatively high rate of Level I or II trauma centers, only 33.3 percent of the population lives within 60 minutes of a Level I or II trauma center. The state also has a below average rate of psychiatric care beds (25.7 per 100,000 people).
Recommendations. South Dakota must implement programs to improve traffic safety and the overall health of its population. Implementing a primary seat belt law would be a step toward improving the state’s high traffic fatality rate and low rate of seat belt use. Targeted investment in injury prevention programs might also be used to address the state’s high rates of fatal injuries.
The state should also develop programs and devote resources to pursue improvements within the EMS system and other quality and patient safety priorities. Such improvements could include a uniform system for providing pre-arrival instructions and the development of a statewide trauma registry. The state would also benefit from implementing a hospital-based infections reporting requirement. Requiring training for EMS and hospital personnel in disaster management is another initiative that should be considered.
Emergency physicians in South Dakota have reported transferring patients to facilities more than four hours away for needed emergency care. The state must work to address problems related to crowding and ambulance diversion by collecting and reviewing hospital diversion data as a first step in determining how best to address this issue.
Emergency physicians in South Dakota have also reported a lack of critical on-call coverage. As such, the state should investigate ways to encourage on-call coverage. Additional liability protections for EMTALA-mandated emergency care and expert witness rules may encourage more specialists to provide on-call services.