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Guest Commentary/State Emergency Care

Report card: ‘F’ for psychiatric beds

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By Enrique Enguidanos, MD
The American College of Emergency Physicians gave Washington a D+ in its state-by-state report card on America’s emergency care environment. This score addresses statewide policies and resources, and does not reflect the high-quality bedside care we see delivered in our emergency departments every day. Within the report card, Washington’s scores ranged from an A minus to an F. As most parents know, a child who brings home a report card with this broad variation of grades is bright and has a lot of potential, but isn’t paying attention and focusing in class. The same is true for our state.
In areas where Washington has focused its policies and resources, we’ve scored well. We received an A minus in Public Health and Injury Prevention due a heightened focus on areas such as seatbelt laws and anti-smoking ordinances. We also scored highly in Quality and Patient Safety Environment, a result of the work our state has done to develop protocols and procedures relating to heart attack, stroke and trauma patients. We have seen particularly strong collaboration between Snohomish County EMS providers and hospitals to coordinate care for these critically-injured patients.
In areas where we haven’t focused our attention and resources as a state, we scored poorly. We received an F in Access to Emergency Care, primarily due to our state’s lack of resources for patients with mental health issues. We have only 8.3 psychiatric beds per 100,000 people, the third worst in the nation. While in Snohomish County the news is a bit brighter. Three companies are in the process of soliciting the state to add inpatient psychiatric beds. However, public funding is needed to increase access for Medicaid patients. As director of an emergency department, I see the impact of this almost every day. Patients requiring psychiatric help spend many hours languishing in the Emergency Department waiting for an inpatient psychiatric bed to open and so few are available in the state.
Likewise, we received an F for disaster preparedness. The state’s per capita federal disaster preparedness funds have dropped from $7.09 per person in 2009 to $5.31 in 2013. The state does not have a budget line item for disaster preparedness funding specific for a health care surge, nor do we have an adequate statewide medical communication system for a disaster.
Washington state emergency departments and hospitals provide outstanding care every single day. But the best medicine in the world can’t help you if you can’t access it, particularly in a disaster. We need to pay attention to disaster response capabilities, with a better coordinated statewide effort. Our policymakers also need to focus attention on providing more staffed inpatient beds for psychiatric patients. With an increased focus and expanded effort in these key areas, Washington state can realize its high potential across disciplines. Anyone who is interested can find more details at
Dr. Enrique Enguidanos is the Emergency Department Medical Director at Providence Regional Medical Center.

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