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Interhospital Transfer: Transfer Processes and Patient Outcomes
Stephanie K Mueller1,2, Julie Fiskio1, Jeffrey Schnipper1,2
1Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Journal of Hospital Medicine
|April 16, 2019
Summary
Interhospital transfers at night or during busy periods are linked to worse patient outcomes, including higher intensive care unit (ICU) admission and 30-day mortality rates.
Area of Science:
- Healthcare Management
- Patient Outcomes Research
- Medical Transfer Logistics
Background:
- Interhospital transfer (IHT) aims to provide specialized care but is linked to adverse patient outcomes.
- Specific transfer process elements may contribute to these negative outcomes.
Purpose of the Study:
- To investigate the association between transfer timing (nighttime, weekend), transfer delays, and care team busyness with patient outcomes.
- To analyze the impact of these factors on intensive care unit (ICU) transfer and 30-day mortality.
Main Methods:
- Retrospective cohort study of 24,352 adult patients undergoing IHT to a tertiary care hospital (2005-2013).
- Multivariable logistic regression models adjusted for patient characteristics.
- Secondary analyses examined detailed timing and stratified outcomes by service.
Main Results:
- Nighttime transfers were associated with increased odds of ICU transfer (OR 1.54) and 30-day mortality (OR 1.16).
- Sunday night transfers showed increased 30-day mortality compared to Monday daytime transfers.
- Significant associations between transfer characteristics and mortality were found for cardiothoracic and gastrointestinal surgical services.
Conclusions:
- High-acuity patients experience worse outcomes during off-peak transfer times and periods of high care team workload.
- Further research is needed to identify underlying mechanisms and develop mitigation strategies for adverse transfer-related outcomes.
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