Buncombe County EMS implements Mission Hospital handoff policy to address long wait times

Mitchell Black, Asheville Citizen Times
·3 min read
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ASHEVILLE – Buncombe County implemented a handoff policy for patients arriving in ambulances at Mission Hospital late last week, county spokesperson Kassi Day confirmed.

The policy allows Emergency Medical Service workers to leave stable patients in the hospital staff’s care shortly after arriving in an ambulance, even if beds are not available for patients.

County Manager Avril Pinder and EMS Director Taylor Jones notified Mission leaders that it would implement the rapid handoff policy in a Nov. 3 letter. This policy, they said, would improve EMS response times and keep Mission from effectively receiving a taxpayer subsidy from the county. The amount of time paramedics wait with patients will depend on how many county EMS vehicles are in service. EMS personnel will wait less if there are fewer ambulances in service.

Ambulances parked outside of Mission Hospital.
Ambulances parked outside of Mission Hospital.

The county proposed the policy because patients arriving in ambulances at Mission can wait extended periods of time before receiving care, a patient and emergency services safety concern highlighted by the Citizen Times in June. Hospital staff and local emergency service leaders blamed the long wait times on an overtaxed emergency department and an understaffed hospital patient care team, explaining that the hospital does not have enough staff to expeditiously treat, admit and discharge patients.

County staff allowed Mission until Dec. 15 to fix the problem before implementing the policy, according to the letter.

Mission Hospital spokesperson Katie Czerwinski did not respond to the Citizen Times' request for comment by press time.

Attorney General Josh Stein cited this concern in a complaint filed against the Mission and its corporate owner, HCA Healthcare, last week. HCA bought the Mission Health system for $1.5 billion in 2019.

The lawsuit alleged that Mission and HCA did not provide the emergency services and cancer care services it agreed to when it bought the system in 2019. Stein, who is running for governor, requested that the court demand HCA and Mission restore the level of service in these areas to its pre-sale conditions.

The lawsuit claimed that the HCA is not providing the level of medical transport services consistent with the trauma program in place prior to the sale. It cited lengthening or extended wait times from Buncombe County, Reems Creek, McDowell County and Fairview EMS systems in the legal filing.

North Carolina Attorney General Josh Stein held a press conference, December 14, 2023, after filing a lawsuit accusing HCA Healthcare of failing to provide the level of emergency and cancer care it agreed to when it purchased the Mission Health system in 2019.
North Carolina Attorney General Josh Stein held a press conference, December 14, 2023, after filing a lawsuit accusing HCA Healthcare of failing to provide the level of emergency and cancer care it agreed to when it purchased the Mission Health system in 2019.

Stein included affidavits from Jones and four other local emergency services leaders in the filing.

In his affidavit, Jones said that the number of Buncombe County patient transports to Mission Hospital increased by about 20% since 2018. In 2023, roughly 5,600 Buncombe patients have been transported to the hospital, he said.

At the same time, the proportion of patients transferred to the hospital’s care within 20 minutes, the industry-wide standard for EMS transfers, have decreased by around 22%, he said.

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“There are not enough staffed beds on patient floors at Mission Hospital, and because of this there are beds that are left empty,” he said. “This has a direct effect on how long patients must wait for rooms.”

“I have noticed that due to these issues, it is practically guaranteed at this time that there will be some time each day when no ambulances are available.”

Buncombe County EMS is not the only entity to implement a policy to address these extended wait times. McDowell and Yancey County emergency service leaders implemented their own policies as well. Fairview EMS Coordinator Landon Miller, whose affidavit was also included in the filing, told the Citizen Times Dec. 18 that the department is developing a policy similar to Buncombe.

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: Buncombe EMS implements Mission handoff policy for ambulance patients