Ambulance delays at Mission ER raise concerns

ASHEVILLE, N.C. (WLOS) — Every second matters in an emergency. So, imagine needing an ambulance, but not getting one as quickly as you should.

News 13's investigation into services at Mission Hospital two years after the sale to HCA continues.

Buncombe County EMS told News 13 ambulances are being held up in Mission's Emergency Department and that affects the entire system responding to mountain emergencies.

In an emergency, the numbers 9-1-1 get an immediate response.

It’s another set of numbers that has Buncombe County EMS Division Manager Jamie Judd's attention.

“Utilization hours are a big deal to us, how quickly we can keep units in service,” Judd said.

For an ambulance service, not only does it worry about its response time getting to a patient in need, but it is also concerned about the time it takes to arrive at the hospital and the time until that ambulance can be cleaned and returned to service.

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How districts are impacted

In South Asheville, it's not uncommon for Skyland Paramedics to make six transports with patients to Mission Hospital a day.

Once that ambulance arrives at Mission Hospital, it's out of service until the hospital accepts the patient. Life-threatening situations like a stroke or heart attack get priority.

“We will bypass the emergency department. We’ll go straight through. That person goes straight up to the cath lab,” Skyland Fire and Rescue EMS coordinator Tim Hinman said.

Depending on the severity of the patients' conditions, others may wait, Hinman said..

“Somebody who has fallen and broken their leg, and let’s not diminish that, and if it’s an obvious fracture, but if you lay there on the stretcher for another 30 minutes, it’s not going to diminish your outcome,” Hinman said.

When Skyland's ambulances or any other district's EMS are forced to wait, other EMS districts must respond in Skyland and elsewhere until their ambulances are back in service.

“During peak times, it’s not unusual to see three, sometimes even four ambulances from other districts to have to respond into the south end of Asheville,” Hinman said.

There’s no national standard for when an ambulance should clear from the hospital. Buncombe County EMS’s goal is to have a patient checked and turned over to hospital staff within 20 minutes of arriving at the emergency department.

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Average times

Before the sale to HCA, Buncombe County was averaging, 31 minutes and 54 seconds in 2018 at Mission Hospital. In 2019, the average time was up slightly to 32 minutes and 36 seconds. In 2020, a year with fewer transports, it climbed to 34 minutes and 18 seconds on average from January through November. Sometimes, the waits can be even longer. Those are what concerns Buncombe County.

But, at times, patients have been held in an ambulance at the hospital for 30, 40, 50 minutes.

"Those tend to be the outliers. But those are the ones that generally catch our attention. It’s not necessarily waiting in the ambulance to go in, but waiting in the emergency department for a bed to become available so we can transfer that patient over," Judd said.

When Buncombe County reviewed its longest wait time averages, in 2018, those times were averaging 48 minutes and 17 seconds. In 2019, those times averaged 49 minutes and 49 seconds. And, from January to November 2020, the average was 51 minutes and 46 seconds.

Judd said those numbers are concerning to Buncombe County EMS.

"Again, you know, it could potentially be delaying some patient care,” Judd said.

News 13 requested average times across mountain hospitals from 2018-20.

In Henderson County in 2018, EMS wait times at AdventHealth and UNC Pardee averaged 16 minutes. In 2019 at AdventHealth, it dropped to 15 minutes and 33 seconds, while at UNC Pardee it was up to 16 minutes and 8 seconds. In 2020, AdventHealth times climbed to 18 minutes and 36 seconds and UNC Pardee's turnaround times averaged 19 minutes and 27 seconds.

In Haywood County, EMS in 2018 saw an average turnaround time of 25 minutes and 35 seconds. In 2019, it improved to 23 minutes and 49 seconds. And in 2020, EMS was averaging 26 minutes and 21 seconds.

According to Transylvania County EMS, the average turnaround time at Transylvania Regional Hospital in 2018 was 13 minutes and 54 seconds. In 2019, the turnaround time averaged 14 minutes and 42 seconds. And in 2020, average times were about 15 minutes and 1 second. According to Transylvania Regional EMS, its goal is to have units ready to respond within 10 minutes of arrival and clear from the hospital within 30 minutes.

Compared to Mission Hospital's Emergency Department, the previously mentioned hospitals are all smaller hospitals with fewer patients.

News 13 also compared Mission Hospital's times to North Carolina hospitals of a similar size. In New Hanover County, EMS in 2018 averaged 27 minutes and 29 seconds to get back in service. In 2019, it was 30 minutes and 1 second. And in 2020, times averaged 30 minutes and 32 seconds. In Pitt County, because of a system change, EMS could only provide times for 2020. Pitt County's average time at Vidant Health was 27 minutes.

Buncombe County EMS has discussed its concerns with Mission Hospital executives.

“They were happy to meet with us. We’ve sat down multiple times over the last year, looked at our data, looked at things we can do on both sides to help,” Judd said.

In a statement, Mission's spokesperson said the hospital has a strong relationship with EMS. According to Mission, it has "recently added a second ER nursing supervisor whose responsibilities include ensuring EMS patients are cared for in a timely fashion."

According to Mission officials, records show that from the ambulance until the patient is transferred to ED treatment space, the hospital averages no longer than 9 minutes, often less. Mission Hospital calls it an offload time, which is different than EMS utilization times and what they call a turnaround time at the hospital.

"EMS offload times for the hospital are defined as the following: the time of transfer of the patient from the EMS stretcher to the ED treatment space with the assumption of care by ED staff," a Mission Hospital spokesperson said. "We strive to return EMS to the community they serve as quickly as possible to meet both the needs of the EMS staff and the needs of the community, who may be waiting on the availability of that ambulance. Mission Hospital has never exceeded 9 minute offload times since December 2019 (only hitting 9 minutes once in September 2020), and most monthly averages are 5-6 minutes."

According to Buncombe County EMS, while treatment is underway, ambulance crews can't move on until they have a signature from ER staff, a wait which can average between 15 and 25 minutes.

Can the issues be fixed?

“The hospital’s been very receptive to our feedback and wanting to correct the problem,” Judd said when asked what's being done to address delays.

A Mission representative pointed out, because many have delayed care during the pandemic, those now coming to the ER have more serious conditions to address.

“They’re starting some basic assessments and orders while they’re still sitting in our beds. But again, that time to get our unit back in service, to get back into the field to respond to the next call, that’s where we see the impact on us,” Judd said.

Efforts are aimed at bringing down times to get ambulances back on the road so patient safety isn't at risk waiting in an emergency.

“That's the priority, getting the best care to the patient at the right time,” Judd said.