Interfacility transfer of the critically ill: Transfer status does not influence survival

Area of Science:

• Critical Care Medicine
• Health Services Research
• Patient Outcomes

Background:

• Interfacility transfer of critically ill patients is common.
• Understanding the impact of transfers on patient mortality is crucial for optimizing care.

Purpose of the Study:

• To compare case-mix adjusted hospital mortality between adult intensive care unit (ICU) patients who are transferred during their ICU stay and those who are not.

Main Methods:

• Analysis of 19,260 ICU visits across 12 ICUs in Nova Scotia, Canada (April 2018-September 2023).
• Utilized Generalized Additive Models (GAMs) to estimate differences in case-mix adjusted hospital mortality.
• Data sourced from the Nova Scotia Provincial ICU database.

Main Results:

• 5% (1040/19,260) of ICU visits involved interfacility transfer.
• No significant difference in hospital mortality was found between transferred and non-transferred patients (OR, 0.99; 95% CI, 0.82-1.19).
• A potential difference for multiple transfers was observed (OR, 0.68; 95% CI, 0.46-1.00, p=0.05) but not confirmed in sensitivity analysis.

Conclusions:

• Transferring critically ill patients between ICUs in Nova Scotia did not significantly impact case-mix adjusted hospital mortality.
• No difference in mortality was observed between single or multiple transfers compared to no transfers.