The long and winding road: do patients deteriorate during long ambulance journeys to hospital.

OBJECTIVES & BACKGROUND: Previous investigators have demonstrated increased mortality with longer distance from hospital in respiratory patients but it is unclear if these findings are applicable to all patients/conditions. However, it is widely assumed that patients may deteriorate during long journeys, which contributes to fear of service reconfiguration by public and professionals alike. We wished to ascertain whether clinical deterioration occurs during long ambulance journeys (up to 70 miles) to hospital from our rural catchment area.

METHODS: Retrospective chart review of adult medical/surgical patients arriving at our ED by land ambulance from home. Trauma and psychiatric cases were excluded.Power calculation, based upon a previous pilot study, required a sample of 635 to achieve a power of 0.8 at alpha 0.05, assuming the true partial correlation to be at least 0.15. Spearman's correlation coefficient was used.A convenience sample of 991 patients was used between September 2013-April 2014.The NHS Early Warning Score (NEWS) was used to estimate illness severity on ambulance arrival at scene ("pick-up") and to ED ("arrival") and relationship with distance from hospital analysed.We subtracted "arrival" from "pick-up" NEWS as a measure of clinical deterioration, and correlated with distance from hospital.

RESULTS: There was no statistically significant relationship between clinical deterioration and distance from hospital. When sub-categorised into clinical groups (e.g. respiratory, cardiology etc.) there continued to be no correlation between deterioration en-route and distance

CONCLUSION: Our findings suggest that adult patients living further from hospital are not more unwell on pick-up, they are not deteriorating en-route, and longer journeys to hospital do not necessarily lead to patients coming to harm.However, we did not explore any relationship to later mortality/morbidity.We appeal to colleagues in those areas of the UK with electronic ambulance records linked to hospital records to repeat this work with a much larger sample and wider range of end-points, in order to provide a definitive answer to this important question.