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

Nicholl, Jon; West, James E.; Goodacre, Steve; Turner, Janette

doi:10.1136/emj.2007.047654

Cited by 209 publications

(166 citation statements)

References 11 publications

Supporting

Mentioning

160

Contrasting

Order By: Relevance

“…This effect of distance on mortality of emergency admissions for respiratory illness can be observed in the large cohort of 668 patients presenting with 'respiratory disease' across four ambulance services over a 4-year period from 1997 to 2001. 6 This relationship can be observed in the raw data, as shown in Figure 7, which show an increase in mortality with an increase in the distance to hospital. Appendix 8 shows mortality variation with distances, categorised as short (< 10 km), medium (10-20 km) and long (> 20 km), with longer distances associated with higher mortality.…”

Section: Scenarios For Cost-effectiveness Analysismentioning

confidence: 68%

“…The risk of death in patients with respiratory problems increases markedly with distance travelled to hospital, from 10% at distances below 10 km to 20% at distances over 20 km. 6 This may be because many hospital treatments for acute hypoxaemic respiratory failure, particularly those involving respiratory support, are not routinely available in the pre-hospital setting.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

“…6 These were the Royal Berkshire Ambulance Service, the Derbyshire Ambulance Service, the Essex Ambulance Service and the West Midlands Ambulance Service. These ambulance services were representative of the types of environment typically encountered in England and included urban, mixed urban and rural, and very rural areas.…”

Section: Mortality Riskmentioning

confidence: 99%

See 2 more Smart Citations

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Pandor

Thokala

Goodacre

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundNon-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources.ObjectivesWe aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to the emergency services with acute respiratory failure and to identify priorities for future research.Data sourcesFourteen electronic databases and research registers (including MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2013, supplemented by hand-searching reference lists and contacting experts in the field.Review methodsWe included all randomised or quasi-randomised controlled trials of pre-hospital NIV in patients with acute respiratory failure. Methodological quality was assessed according to established criteria. An aggregate data network meta-analysis (NMA) of mortality and intubation was used to jointly estimate intervention effects relative to usual care. A NMA, using individual patient-level data (IPD) and aggregate data where IPD were not available, was carried out to assess whether or not covariates were treatment effect modifiers. A de novo economic model was developed to explore the costs and health outcomes when pre-hospital NIV (specifically CPAP provided by paramedics) and standard care (in-hospital NIV) were applied to a hypothetical cohort of patients with acute respiratory failure.ResultsThe literature searches identified 2284 citations. Of the 10 studies that met the inclusion criteria, eight were randomised controlled trials and two were quasi-randomised trials (six CPAP; four BiPAP; sample sizes 23–207 participants). IPD were available from seven trials (650 patients). The aggregate data NMA suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639), and reduced both mortality [odds ratio (OR) 0.41, 95% credible interval (CrI) 0.20 to 0.77] and intubation rate (OR 0.32, 95% CrI 0.17 to 0.62) compared with standard care. The effect of BiPAP on mortality (OR 1.94, 95% CrI 0.65 to 6.14) and intubation rate (OR 0.40, 95% CrI 0.14 to 1.16) compared with standard care was uncertain. The combined IPD and aggregate data NMA suggested that sex was a statistically significant treatment effect modifier for mortality. The economic analysis showed that pre-hospital CPAP was more effective and more expensive than standard care, with an incremental cost-effectiveness ratio of £20,514 per quality-adjusted life-year (QALY) and a 49.5% probability of being cost-effective at the £20,000-per-QALY threshold. Variation in the incidence of eligible patients had a marked impact on cost-effectiveness and the expected value of sample information for a future randomised trial.LimitationsThe meta-analysis lacked power to detect potentially important differences in outcome (particularly for BiPAP), the intervention was not always compared with the best alternative care (in-hospital NIV) in the primary studies and findings may not be generalisable.ConclusionsPre-hospital CPAP can reduce mortality and intubation rates, but cost-effectiveness is uncertain and the value of further randomised evaluation depends on the incidence of suitable patients. A feasibility study is required to determine if a large pragmatic trial of clinical effectiveness and cost-effectiveness is appropriate.Study registrationThe study is registered as PROSPERO CRD42012002933.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Scenarios For Cost-effectiveness Analysismentioning

confidence: 68%

Section: Chapter 1 Backgroundmentioning

confidence: 99%

See 1 more Smart Citation

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Pandor

Thokala

Goodacre

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…2 ED crowding leads to ambulance diversion, 54 which can delay care and increase mortality rates. 55 One of the main causes of ED crowding is the boarding of admitted patients. 56 Boarded, admitted patients have been shown to have decreased quality of care and patient satisfaction.…”

Section: Active Bed Managementmentioning

confidence: 99%

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

Chadaga

Maher

Maller³

et al. 2012

Journal of Hospital Medicine

View full text Add to dashboard Cite

Hospitalists are uniquely positioned to implement strategies to improve patient flow and efficiency. Hospital leaders have stated they expect hospitalists to comanage surgical patients, participate in observation units, and screen medical admissions, in addition to providing inpatient care for medical patients. We review how the hospitalists' role in acute inpatient care, surgical comanagement, short stay units, chest pain units, and active bed management has improved throughput and patient flow. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

show abstract

“…Nicholl et al 26 The relationship between distance to hospital and patient mortality in emergencies: an observational study.…”

Section: Health Aff (Millwood) Internationalmentioning

confidence: 99%

International Emergency Medicine: A Review of the Literature from 2007

Levine

Becker²,

Lippert³

et al. 2008

Academic Emergency Medicine

View full text Add to dashboard Cite

The subspecialty of international emergency medicine (IEM) continues to grow within the United States, just as the specialty of emergency medicine (EM) continues to spread to both developed and developing countries around the world. One of the greatest obstacles, however, faced by IEM researchers and practitioners alike, remains the lack of a high-quality, consolidated, and easily accessible evidence-base of literature. In response to this perceived need, members of the Emergency Medicine Resident Association (EMRA) International Emergency Medicine Committee, in conjunction with members of the Society for Academic Emergency Medicine (SAEM) International Health Interest Group, have embarked on the task of creating a recurring review of IEM literature. This publication represents the third annual review, covering the top 30 IEM research articles published in 2007. Articles were selected for the review according to explicit, predetermined criteria that included both methodologic quality and perceived impact of the research. It is hoped that this annual review will act as a forum for disseminating best practices, while also stimulating further research in the field of IEM.ACADEMIC EMERGENCY MEDICINE 2008; 15:860-865 ª

show abstract

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

Cited by 209 publications

References 11 publications

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

International Emergency Medicine: A Review of the Literature from 2007

Contact Info

Product

Resources

About