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McDowell EMS Enacts 45-Day Pause on Interfacility Transfers due to Extended Wait Times at Mission Hospital Asheville
 
Marion, NC November 1, 2023 - McDowell EMS leaders have taken a decisive step by implementing a 45-day pause on interfacility non-emergent transfers between McDowell Hospital and Mission Hospital in Asheville.  Emergency Services Director Will Kehler sent a letter to HCA Leadership on Monday, October 30th highlighting the decision and the continued issues EMS is encountering at Mission Hospital in Asheville.  Paramedics are increasingly being frozen in place inside the emergency department in Asheville as they must continue providing care until the hospital takes charge.  Ambulance patient offload times (APOT) that should take 20 to 30 minutes now frequently stretch for hours as paramedics wait for patients to be transferred to a clean room with a nurse at the bedside.
 
An interfacility transfer is a crucial component of the healthcare system, involving the movement of patients from one healthcare facility to another to access specialized care or services that are not available at the originating hospital. In the context of Mission Hospital McDowell and Mission Hospital Asheville, the current process entails patients being transferred from McDowell Hospital to Mission Hospital's Emergency Room (ER) when the need arises, and the receiving hospital's specialized units or beds are not immediately available.
 
Long wait times for interfacility transfers have been a persistent issue, creating strains on EMS resources and impacting patient care. The 45-day pause on non-emergency transfers going from McDowell Hospital to Mission in Asheville is a significant response to the lack of meaningful solutions from HCA Leadership in Asheville.  “Our agency has worked with HCA for more than a year now to address and improve the extended wait times at Mission Hospital,” states Emergency Services Director Will Kehler.  “Unfortunately, we are making no progress and the situation is getting worse. Paramedics waiting 1-2 hours in the ER for a bed and a nurse to assume care is a situation that should never be deemed acceptable.  Protecting the safety of McDowell County citizens is our top priority. EMS paramedics and ambulances must be readily available within our community to respond to emergencies.”
 
McDowell EMS and Regional Transfer Services (RTS), a Mission Health transport service, jointly handle interfacility transfers from Mission Hospital McDowell to Mission Hospital Asheville, a crucial service for ensuring that patients receive the specialized care they need. So far in 2023, McDowell EMS has averaged approximately 53 transfers per month, while RTS handles an average of 85 transfers monthly.
 
During the pause, resources will be managed to address emergency transfer requests, ensuring that patients in need of emergency transfer from McDowell Hospital for life saving care will not be delayed.  “A significant number of our long wait times at Mission Hospital in Asheville are occurring with stable patients who are being transported from McDowell Hospital for a higher level of care,” states Kehler.  “These patients are commonly waiting 1-2 hours before they are placed in a clean bed at Mission.  Our ambulances cannot continue to encounter prolonged wait times and not be available for 911 calls inside McDowell County.  The current situation is unacceptable and significantly impacts ambulance availability in McDowell while jeopardizing the safety of our citizens. Our mission is patient-centered care, where every decision, every action, and every second is dedicated to delivering the best possible outcome for the individuals we serve.  EMS leadership stands ready to collaborate with hospital leaders to navigate the challenges of ER wait times.”
 
Delayed Emergency Care Puts Communities at Risk
 
Ambulances are the lifeline of communities, providing rapid response and critical care in times of emergencies.  McDowell EMS strives to always have an ambulance available for those having a medical or trauma emergency, according to Kehler, but extended ER wait times could cause unavailability of ambulances in the county. 
 
Paramedics find themselves in situations where they need to retrieve essential medical supplies, including medications and additional oxygen, from their ambulances to sustain patient care while awaiting an available bed and a receiving nurse according to EMS Deputy Director Adrienne Rivera Jones.   “We are treating patients inside the emergency department, literally on the wall while we wait for a hospital bed inside the ER. Dangerously long wall times are arguably one of the most significant emergency medical crises happening in our community,” noted Jones.
 
The connection between long ER wait times and EMS response times is undeniable. The delay in transferring patients from ambulance care to hospital care has far-reaching consequences, impacting patient outcomes and the overall health and safety of our communities. Ambulances tied up in the ER are unavailable to respond to new emergency calls.  As the number of available ambulances dwindles due to ER wait times, 911 response times increase. Patients who urgently need assistance may experience potentially life-threatening delays in receiving care.
 
This pause, which is set to begin on November 6, represents a critical juncture in the quest for improved patient care and more efficient emergency medical services. The hope is that HCA Leadership will work with McDowell EMS to implement solutions that prioritize the well-being of patients and ensure the healthcare system meets the needs of those it serves.