Does centralisation improve outcomes? Or does it deskill local centres and lead to worse outcomes? What about the penalty of moving a critically ill patient?
Here is an interesting paper on the travel question. And a rather massive study too - 58 000 admissions over 4 years to 29 paediatric intensive care units. In England and Wales, most units send specialist teams to collect their patients. The study clearly shows that patients retrieved by specialist teams did better than those collected by non-specialist teams.
But I'm not so happy with the authors' conclusion that 'the distance travelled by patients.. did not seem to affect their outcome'.
The odds ratios for mortality by distance travelled, shown as quartiles, are as follows:
1 : 1.01 : 1.24 : 1.42.
Seems a pretty clear pattern to me, but the 'not affected' conclusion is because in each case the 95% confidence on the odds ratio includes 1 (i.e. no effect). But it seems to me that we have a strong possibilty here of a Type II error i.e. we say that this pattern of odds ratios is simply due to chance when in reality it is not.