Monthly Vital Statistics
September 1997, Vol. 31, No. 7
Buyer's Guide to Hospital Emergency Services
The most recent in a series of consumer reports on
Missouri's health care system has been issued by the Missouri
Department of Health with the release in November of a buyer's
guide to emergency department services. The guide is published
for each of five regions in the state (see Map 1) to help consumers
make informed decisions before the need for emergency treatment
arises.
The one hundred twenty-eight community hospitals
in the state that have an emergency room are included.
Data came from three sources: an emergency department
(ED) survey sent to the hospitals, the Annual Licensing Survey
sent by the facilities each year to the Department of Health and
a patient satisfaction survey sent to some patients who had visited
emergency departments around the state.
Facility Information
Most emergency departments (114 of the 128) are staffed
by medical personnel dedicated to ED services 24 hours per day,
seven days per week. The remaining 14 hospitals have other arrangements
for ED coverage.
Emergency Department Levels range from Level I hospitals
which offer the most comprehensive care to Level 4s which offer
lifesaving first aid and referral to another hospital where definitive
care can be provided. Facilities select their level of emergency
care based upon these guidelines. In 1997, hospitals categorized
themselves as shown in Table 1.
Trauma centers provide emergency and specialized
intensive care to critically ill and injured patients. As shown
in Table 2, 33 Missouri hospitals have been designated as trauma
centers by the Bureau of Emergency Medical Services in 1997. Level
I trauma centers provide total care for every aspect of injury
and illness while Level II and Level III trauma centers may transfer
some seriously injured patients to Level I facilities.
Of the nine Level I trauma centers, one is in Central
Missouri, three are in Kansas City and five are in the St. Louis
area. Three of the nine are for pediatric patients only. The Southwestern
region has four of the 14 Level II and two of the 10 Level III
trauma centers. The closest trauma center of any level to southeastern
Missourians is in Farmington which has a Level III facility.
Other facility information that consumers may find
useful is that fifty hospitals have "fast-track care"
available within the hospital confines to expedite services for
urgent or nonurgent patients. The average number of emergency
visits to all hospitals in 1995 was 16,559. The range was from
a low of 321 to a high of 65,501.
Emergency Services Personnel
Most hospitals (110) have an ED medical director
who is board-certified or board-eligible in a specialty, the majority
in Emergency Medicine or Family Practice. Thirty-one hospitals
do not have a full-time physician on staff who is board-certified
or board-eligible in a specialty and twenty hospitals have no
full-time ED physician.
The medical director of 126 of the 128 hospitals
has Advanced Cardiac Life Support (ACLS) training and 106 of them
have Advanced Trauma Life Support (ATLS) training. There are two
hospitals where the medical director does not have either type
of training.
One hundred eighteen EDs are covered by registered
nurses dedicated to ED services 24 hours per day, seven days per
week for emergency care and 102 have 100 percent of their ED nurses
who have completed ACLS training.
Ninety-eight of the facilities have medical specialists
on-call 24 hours per day but there are 39 hospitals with no mental
health provider on-call.
The facilities in the Central Missouri region rank
lowest of all the regions in this category while the St. Louis
area hospitals ranked highest.
Pediatric Capabilities
Seventy-eight of the EDs have a medical director
who has completed Pediatric Advanced Life Support (PALS) training
and 18 have all of their RNs completing this training. Twenty-nine
facilities have ED nurses with no specialized pediatric training.
Relatively few hospitals (25) have a full-time or a part-time
pediatrician on staff. One hundred-eighteen facilities have special
pediatric trays on hand to deal with childhood emergencies and
twenty-two of the facilities have a team of medical personnel
devoted to the identification and appropriate treatment of children
who arrive in the ED with signs or symptoms of child abuse and/or
neglect.
The facilities in the Central Missouri region rank
lowest of all the regions in this category while the St. Louis
area hospitals ranked highest, possibly because two of the three
children's hospitals in the state are in this region.
Other Information
Other areas of the guide that could be helpful to
those who may seek emergency care are those that tell the consumer
about the support that is available from other departments in
the hospital such as the 24-hour availability of operating rooms
and ICUs. The Southeastern region ranked highest in this support
services area and the Central region ranked lowest.
The amount of time spent waiting for services was
figured for different types of patients: those who were true emergencies
because their illness or injury was life- or limb-threatening
and they needed immediate medical attention; those whose illness
or injury was not as severe but was time sensitive and they were
in need of prompt medical care; and those who were in the emergency
room for an illness or injury that was neither life- or limb threatening
nor time sensitive. The Southwestern region facilities ranked
best in the "waiting time" category and the St. Louis
region hospitals ranked lowest.
There is also information about the quality improvement
activities undertaken by each facility and about their policies
and protocols when triaging patients and treating and transferring
those who need specialized care of an intensive nature.
Patient Satisfaction
We used a patient satisfaction survey instrument
developed by The Picker Institute of Boston, MA. The survey
was designed for adult patients so the three children's hospitals
in the state were not included. The survey was optional on the
part of the facilities, but 113 facilities did participate.
Questions were combined into six groups called dimensions
of care. Table 3 shows these groups and how hospitals in the different
regions of the state were ranked by their patients. In general,
patient satisfaction was high in the Kansas City area which includes
Jackson, Clay and Platte counties and in the Central Missouri
region and lowest in the Southeast region.
The guide also has sections discussing what every
consumer should know, patient rights and patient responsibilities.
The ultimate goal of all the consumer guides is to enhance medical
care in Missouri. In this series, it is hoped that there will
be continual benefits as hospitals, medical personnel and consumers
work to improve the quality of care that is available to citizens
of our state.
Consumer reports can be obtained by writing the Department
of Health, Center for Health Information Management and Epidemiology,
Post Office Box 570, Jefferson City, MO 65102-0570, by phoning
573/751-6279 or by fax at 573/526-4102. The cost of each guide
is $3.00.
| Table 1
|
| Level of Emergency Care
|
| Number of Hospitals
| Percent |
| Level 1 | 15 | 11.7
|
| Level 2 | 71 | 55.4
|
| Level 3 | 31 | 24.2
|
| Level 4 | 11 | 8.6
|
| Table 2 |
| Trauma Level Centers
|
| Number of Hospitals
| Percent |
| Level I | 9 | 7.0
|
| Level II | 14 | 10.9
|
| Level III | 10 | 7.8
|
| Table 3 |
| Patient Satisfaction Survey Results
|
| Dimension | Respect for Patient Preferences
| Information and Education
| Emotional Support |
Access and Coordination of Care
| Continuity of Care |
Overall Impression of Visit
|
| Region |
| Central | Average
| Average | Average
| High | Average
| Average |
| Kansas City Area | High
| High | High
| Average | High
| High |
| Northwest | Average
| Average | Average
| Average | Average
| Average |
| Southeast | Low
| Low | Low
| Low | Low
| Low |
| Southwest | Low
| Low | Average
| Average | Low
| Average |
| St. Louis Area | Average
| Average | Average
| Low | Average
| Average |
| East | Average
| Average | Low
| Average | Average
| Low |
Map 1
Buyer's Guide Regions
Provisional Vital Statistics for July 1997
Live births increased in July as 6,709 Missouri babies were compared with 6,300 in July 1996. The birth
rate increased from 13.9 to 14.6 per 1,000 live births.
Cumulative births show a slight increase for January-July and a slight decrease for the 12 months ending
with July. The birth rates for the 7-month period ending with July was 13.8 per 1,000 population the same
as 1996.
Deaths decreased slightly in July as 4,288 Missourians died compared with 4,394 one year earlier.
Cumulative deaths for the seven months ending with July show little change in 1997.
The Natural increase in Missouri in July was 2,421 (6,709 births minus 4,288 deaths). The rate went up from
4.2 to 5.3 per 1,000 population.
Marriages increased in July, but show little change for the cumulative 7- and12-month periods ending with
July. Dissolutions of marriage decreased for all three time periods shown below.
Infant deaths decreased in July, but increased for the 7- and 12-month periods ending with July. The infant
death rate for the 12 months ending in July was 8.1 per 1,000 population compared with 7.3 in 1996.
PROVISIONAL RESIDENT VITAL STATISTICS FOR THE STATE OF MISSOURI
July Jan. July cumulative 12 months ending with July
Item Number Rate* Number Rate* Number Rate*
1996 1997 1996 1997 1996 1997 1996 1997 1996 1997 1995 1996 1997
Live Births 6,300 6,709 13.9 14.6 42,924 43,393 13.8 13.8 74,053 73,012 13.9 13.9 13.6
Deaths 4,394 4,288 9.7 9.4 32,831 33,017 10.5 10.5 54,441 54,279 10.1 10.2 10.1
Natural 1,906 2,421 4.2 5.3 10,093 10,376 3.2 3.3 19,612 18,733 3.8 3.7 3.5
increase
Marriages 4,078 4,694 9.0 10.2 24,873 24,838 8.0 7.9 44,396 44,438 8.5 8.3 8.3
Dissolutions 2,297 1,855 5.1 4.0 15,047 14,459 4.8 4.6 25,797 24,850 4.9 4.8 4.6
Infant 49 33 7.2 5.5 323 352 7.4 8.3 540 595 8.0 7.3 8.1
deaths
Population ... ... 5,359 5,395 ... ... 5,359 5,395 ... ... 5,301 5,342 5,380
base (in
thousands)
*Rates for live births, deaths, natural increase, marriages and dissolutions are computed on the number per
1000 estimated population. The infant death rate is based on the number of infant deaths per 1000 live
births. Rates are adjusted to account for varying lengths of monthly reporting periods.
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.
Alternate forms of this publication for persons with disabilities may be obtained by contacting the
Missouri Department of Health, Center for Health Information Management & Epidemiology/Bureau of Health
Data Analysis, P.O. Box 570, Jefferson City, MO 65102; phone (573) 751-6278. Hearing impaired citizens
telephone 1-800-735-2966.