rss
Emerg Med J 2007;24:665-668 doi:10.1136/emj.2007.047654
  • Prehospital care

The relationship between distance to hospital and patient mortality in emergencies: an observational study

  1. Jon Nicholl,
  2. James West,
  3. Steve Goodacre,
  4. Janette Turner
  1. Medical Care Research Unit, University of Sheffield, Sheffield, UK
  1. Correspondence to:
 Professor Jon Nicholl
 Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK; j.nicholl{at}sheffield.ac.uk
  • Accepted 22 May 2007

Abstract

Objectives: Reconfiguration of emergency services could lead to patients with life-threatening conditions travelling longer distances to hospital. Concerns have been raised that this could increase the risk of death. We aimed to determine whether distance to hospital was associated with mortality in patients with life-threatening emergencies.

Methods: We undertook an observational cohort study of 10 315 cases transported with a potentially life-threatening condition (excluding cardiac arrests) by four English ambulance services to associated acute hospitals, to determine whether distance to hospital was associated with mortality, after adjustment for age, sex, clinical category and illness severity.

Results: Straight-line ambulance journey distances ranged from 0 to 58 km with a median of 5 km, and 644 patients died (6.2%). Increased distance was associated with increased risk of death (odds ratio 1.02 per kilometre; 95% CI 1.01 to 1.03; p<0.001). This association was not changed by adjustment for confounding by age, sex, clinical category or illness severity. Patients with respiratory emergencies showed the greatest association between distance and mortality.

Conclusion: Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10-km increase in straight-line distance is associated with around a 1% absolute increase in mortality.

Footnotes

  • Funding: The original ambulance response times study was undertaken by the Medical Care Research Unit, which is core funded by the UK Department of Health. The views expressed here are those of the authors and not necessarily those of the Department.

  • Competing interests: None.

Responses to this article

  • Response to Ashton et al
    • Jon Nicholl,
    • James West, Steve Goodacre, Janette Turner
    Emerg Med J published online February 20, 2008
  • The importance of journey times to hospital in urban areas
    • Charlotte E Ashton,
    • Maggie Harding and Jacqueline Lindo
    Emerg Med J published online November 20, 2007

This Article

  1. Abstract
  2. Full text
  3. PDF

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.