Electronic Letters to:
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eLetters: Electronic letters published:
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Response to Ashton et al
- Jon Nicholl, James West, Steve Goodacre, Janette Turner (20 February 2008)
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The importance of journey times to hospital in urban areas
- Charlotte E Ashton, Maggie Harding and Jacqueline Lindo (20 November 2007)
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Jon Nicholl Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4, James West, Steve Goodacre, Janette Turner
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j.nicholl{at}sheffield.ac.uk Jon Nicholl, et al.
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Sir, Ashton and colleagues are of course right that it is time to hospital that is critical to outcome not distance, and that distance can be a poor proxy for time especially in urban areas. Nevertheless, for the purpose of research we would advocate using distance rather than time, since the former is fixed and objective, but the latter is not well defined, variable, and prone to recording errors. It is variable, even for the same journey at the same time of day in the same conditions, because it depends on the speed and route of the ambulance and this can (and should) depend on how critical the patient’s condition is. Thus the time to hospital is, in part, an outcome of the patient’s condition rather than a contributory cause. Second, time to hospital depends on recording when the ambulance left the scene and when it arrived at hospital. For both of these, practice (that is, how leaving scene and arriving at hospital are defined) and reliability (of ambulance crews accurately recording them) vary considerably. In urban areas with short journey times this variation can double or halve the apparent journey time. The straight-line distance has no ambiguity, no variability, and no recording error and is probably more useful to planners seeking to determine how to configure services. Jon Nicholl, James West, Steve Goodacre, Janette Turner |
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Charlotte E Ashton, Specialty Registrar in Public Health Sutton and Merton PCT, Maggie Harding and Jacqueline Lindo
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charlotte.ashton{at}smpct.nhs.uk Charlotte E Ashton, et al.
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Sir, we found Nicholl et al’s findings on distance to hospital and patient mortality in emergencies both interesting and highly topical. Although the authors justify the use of straight-line ambulance distance opposed to journey times, in urban/inner city areas time to hospital may be a more relevant factor. For instance in Sutton and Merton PCT all general practices have one accident and emergency department within 5km, 64% have two emergency departments within 5km and all practices have at least two emergency departments within 10km. However, due to road systems and heavy congestion within urban and city locations, journey times can still be considerable. For this reason distances may not be representative in determining rapid access. In many cases the closest hospital in terms of distance may not be the most quickly reached in an emergency. As a consequence the average time to reach an accident and emergency unit should be seen as an important factor in London and other densely populated urban areas, particularly at busy times of the day, when there are high levels of congestion. |
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