Mission Hospital ambulance patient wait times lengthen while Buncombe mulls solutions

ASHEVILLE – In July, the Citizen Times reported that patients arriving at Mission Hospital in ambulances can wait hours to receive care. Mission Hospital workers and local emergency service leaders blamed an overtaxed emergency department and understaffed hospital patient care team for the delays, explaining that the hospital does not have staff to expeditiously treat, admit and discharge patients.

Since that report, the wait times have only grown.

During the second quarter of 2023, 24% of Buncombe County ambulance patients’ wait times exceeded 20 minutes. In the third quarter, 27% of Buncombe ambulance patients waited more than 20 minutes to receive care.

These long wait times delay treatment for patients and keep paramedics from traveling to 911 calls.

Mission Hospital spokesperson Nancy Lindell told the Citizen Times in an Oct. 6 statement that the hospital deploys additional staff to the emergency department during surges. She blamed the hospital’s inability to expand “patient capacity” on state certification laws.

“We utilize temporary care locations, alternative care models, and any other means necessary to care for those in need,” Lindell said.

Some county emergency service leaders have taken matters into their own hands, implementing surge policies that allow paramedics to offload patients during long wait times, even if Mission is not ready to accept them. Paramedics factor patient sickness or injury severity and number of ambulances in service into their decision on when to leave.

As of July, Buncombe County was considering its own surge policy. But even as the wait times have lengthened, county officials were unclear on the progress they have made toward implementation.

“We have not officially moved forward with the policy,” Buncombe County Emergency Management Services Division Manager Jamie Judd told the Citizen Times in an Oct. 3 email. “We are able to address issues by working with ED staff when delays happen on a case-by-case basis.”

The North Carolina College of Emergency Physicians released a policy outlining the legality and basic procedure for leaving a patient at the hospital without it accepting care.

“The state office of EMS has released a statement outlining a standard disposition policy that some agencies are adopting,” Kassi Day, Buncombe County spokesperson, told the Citizen Times in an email. “We’re currently looking at what that would entail.”

Day also added that the county is looking into whether it can “bill hospitals for the medical care provided during these extended wait times rather than leaving patients unattended by a medical professional in the ED.”

Buncombe County Board of Commissioners Chair Brownie Newman told the Citizen Times Oct. 6 that the potential policy posed a difficult decision.

“Leaving patients unattended doesn’t sound great,” he said. “Having a slow response time might be even worse.”

Wait times longer for rural counties

Yancey County implemented its own policy Sept. 1, according to its EMS director, Kristy Bryant, who was previously the EMS Liaison at Mission Hospital. Bryant told the Citizen Times the county enacted its own policy because Yancey is a rural county.

“We've got 313 square miles that we must cover with three ambulances,” Bryant said. “We encounter long transport times. A lot of times our EMS units are tied up for three or four hours at a time on one call because we're stuck waiting at the hospital. And then that leaves our county without resources.”

Yancey County relies on Blue Ridge Regional Hospital in Spruce Pine, which is also part of the Mission Health system, for most of its patients. But county paramedics need to take its most serious patients to Mission Hospital in Asheville, according to Bryant. Per figures provided by Bryant Oct. 3, 65% of Yancey County EMS patients waited for care at Mission for more than an hour in 2023. She attributes the excessively high proportion of long waiting periods to the limited frequency the county transports patients to Mission.

Mission's imprint tentatively set to expand

While these wait times have gotten longer, Mission’s imprint is still growing. The hospital received approval on a Certificate of Need application from the North Carolina Department of Health and Human Services for a $29 million freestanding emergency department it intends to build in Candler. It received the approved application Sept. 25.

An administrative law judge reversed NCDHHS’s decision to grant an earlier application for the facility, saying that the state agency failed to hold a public hearing. AdventHealth in Hendersonville appealed that certification. The state health agency also appealed the judge's decision to reverse the preliminary approval for an Arden freestanding emergency department. Mission has not filed a new application for that facility.

AdventHealth spokesperson Victoria Dunkle was noncommittal about whether the nonprofit conglomerate would appeal the recent decision. It has until Oct. 25 to appeal.

Emergency service leaders believe these freestanding emergency departments can help and hurt the long wait times. They can handle low-acuity patients who once funneled to the Mission Emergency department. Officials are concerned however, that patients who arrive in the freestanding facility and need more involved care will need an additional trip, further stressing the system. There are also questions about Mission’s ability to staff the new facility considering the challenges it faces at its main hospital.

More: Judge reverses Mission's certification for Arden ER; NC health department appeals

More: Patients arrive at Mission Hospital in ambulances, then the waiting begins

Bryant said she believes that Mission’s Emergency Department could get major relief if people without life threatening illnesses use the freestanding emergency department, but she has concerns.

“How are they going to staff that?” Bryant asked. Her other concern is transporting patients from the freestanding emergency department to the hospital. “I feel like they are going to heavily rely on Buncombe County EMS.”

She continued, “I feel like that is going to take a county resource away to do those transports as well.”

Mission is looking to contract with a transport service, MedTrust, to help bring patients between facilities. County commissioners are expected to grant the agreement during the next two meetings.

Buncombe County has weighed in on these application discussions before. Newman sent a letter June 2022 on behalf of the entire board to the state department responsible for these applications, supporting a provider other than Mission Health owning 67-bed acute care hospital. The state granted AdventHealth certification of the hospital. HCA has appealed.

The commissioners have not weighed in on the pending freestanding emergency department application. Newman said he wanted more information before he formed an opinion on whether to weigh in.

“What I’ve heard from our staff is that there is a belief that having an additional facility would be beneficial to the public’s interest,” he said. “But they also support the commission’s view that having a greater diversity of providers is also in the community’s interest.”

Mitchell Black covers Buncombe County and health care for the Citizen Times. Email him at mblack@citizentimes.com or follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: Mission Hospital ambulance patient wait times lengthen