Mission ambulance wait times decrease; McDowell EMS resumes patient transfers
ASHEVILLE – McDowell County ambulances will begin transporting noncritical patients to Mission Hospital again after a two-and-a-half-month stoppage. Ambulances resumed transporting patients from Marion-based McDowell Hospital to Mission Jan. 18.
McDowell County Emergency Services Director Will Kehler initiated the pause in November, citing long wait times for ambulance patients arriving at Mission, which backed up the county’s emergency response system.
McDowell County announced it resumed patient transfers in a Jan. 18 news release, noting that wait and turnaround times have decreased since over the past few months.
Buncombe County implemented a handoff policy in December that allowed paramedics to leave stable patients in hospital staff's care shortly after arriving in an ambulance. Spokesperson Kassi Day told the Citizen Times in a Jan. 23 statement that Buncombe has not used the policy in 2024. The county will keep the policy as an option, she said.
A Citizen Times investigation in July highlighted the far-reaching impacts of these extended wait times, which led to delays in treatment and backups for local emergency response. Hospital workers and emergency service leaders blamed an overtaxed and understaffed emergency department on the delays, saying that Mission did not have enough staff to quickly treat, admit and discharge patients. North Carolina Attorney General Josh Stein cited this concern in a lawsuit filed against HCA and Mission in December.
Data provided by county emergency service systems indicate ambulance wait times, also known as wall times, have decreased as HCA has taken preliminary action to address the problem.
Kehler said Mission Hospital leadership discussed a new patient offload process in a December meeting he attended. Paramedics would drop off patients in a designated area in the Emergency Department, with a less-than 10-minute handoff time goal.
Mission emergency department nurse Samantha Phelan told the Citizen Times in a January email that the designated drop-off area was ineffective.
“This process ultimately presented more of a patient and staff safety concern thus was discontinued after less than two shifts,” Phelan said. “The goal was to resolve two primary problems ― getting the ambulance and crew back into the community and initiating patient care faster. Not only were these goals not met, patient safety and privacy were sacrificed.”
On the same day Kehler met with leadership, Dec. 19, regulators from the North Carolina Department of Health and Human Services notified Mission Chief Executive Officer that the department found nine "Immediate Jeopardy" incidents during a series of fall inspections. Officials cited hospital nursing staff for not quickly accepting and monitoring emergency department patients, also noting inadequate staffing in the hospital.
These are the most severe deficiencies regulators can assign, which can lead to the harshest penalties if HCA does not fix the problems.
More: Mission Hospital to implement new ambulance patient handoff policy. HCA gives no details.
Days later, Mission Chief Operating Officer Wyatt Chocklett sent an email to area emergency service leadership, mentioning the work Mission has done to decrease wait times.
“Your crews may have noticed or spoken with HCA Healthcare colleagues around the Mission ED working on better ways we can reallocate our resources to continue to improve on our wait and wall times that have been decreasing for the last few weeks,” Chocklett said. “In addition to some supplemental staff, we are also opening newly restructured inpatient care areas that should aid in these efforts.”
The Citizen Times reached out to Chocklett Jan. 23 but did not receive a response.
Improved patient care, for now
Inside the hospital, staffing and patient intake processes have momentarily improved.
Tucker Richards, an emergency department nurse, told the Citizen Times Jan. 23 that HCA has hired 16 travel nurses to fill the staffing void. Richards said that Mission has opened an area where patients wait to be admitted to the hospital after they are treated in the emergency department. This allows hospital staff to place patients in beds in the emergency department faster, leading to better flow throughout the hospital.
Richards said that the additional staff has allowed the hospital to improve its patient intake process. Unstable patients now are immediately directed to beds in the emergency department. Stable patients are evaluated in a cubicle area in the emergency department before receiving care inside the treatment area.
While he has been pleased with the improvements in the emergency department, he’s not sure that it will persist.
In December, HCA offered nurses extra shifts to improve their staffing short term. That offer ended Jan. 13, according to an automated text message from Mission to nurses, obtained by the Citizen Times.
More: NC investigators cite 9 'Immediate Jeopardy' incidents at Mission Hospital
More: Asheville independent hospital monitor to increase oversight; monitor oversees HCA
But in the interim, tracking from local emergency service providers indicate that the ambulance patient wait times have decreased. The extended wait times have fallen from October to the end of December for emergency services departments in Fairview, Henderson and Buncombe counties.
“We're all very concerned, very skeptical that once this period of immediate jeopardy passes, whether HCA will continue to staff us at this level,” Richards said. “It seems very suspect.”
Lindell did not say whether the changes HCA has made will become permanent in a response to a Citizen Times request.
"There are many factors that influence the details of hospital operations. What is important for the community to know is that our ongoing efforts for improvement are resulting in decreasing wait times for both patients and EMS," she said Jan. 23.
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 ER improvements lead to shorter ambulance wait times
