Prevalence and Characteristics of Potentially Avoidable Interhospital Transfers

Interhospital transfer (IHT) among hospitalized medical patients is common, yet little is known about which patients undergo potentially avoidable IHT.

To determine the prevalence and characteristics associated with potentially avoidable IHT among hospitalized medical patients.

This cross-sectional study was conducted across 16 US referral hospitals. Participants were randomly selected adult medical patients who underwent IHT to participating hospitals between March 1, 2022, and October 31, 2023. Data were analyzed December 2025 through May 2026.

Demographics, primary diagnosis category, and severity and vulnerability risk scores obtained from the Vizient Clinical Data Base, and transfer process characteristics obtained through targeted electronic health record review.

Potentially avoidable transfers were defined as transfers in which care needs could have been met through an alternative to transfer, managed at the transferring hospital, or did not require urgent management during that hospitalization. Two trained adjudicators independently rated transfer appropriateness using a 6-point Likert scale (highly inappropriate through highly appropriate) and reached consensus; transfers rated inappropriate were classified as potentially avoidable. Multivariable logistic regression clustered by site was used to identify characteristics associated with avoidable IHT, correcting for multiple testing.

Of 1560 medical patients transferred, the mean (SD) age was 59.2 (16.4) years, and 901 (57.8%) were male. Overall, 374 transfers (24.0%) were classified as potentially avoidable. Among these transfers, 250 (66.8%) had a care need that could have been managed at the transferring hospital, 186 (49.7%) could have been managed using at least 1 alternative to transfer under current systems of care, and 233 (62.3%) under ideal systems of care, with teleconsultation the most commonly identified alternative (111 [29.7%] for current care and 165 [44.1%] for ideal care). Factors associated with greater adjusted odds of avoidable IHT included transfer delayed more than 24 hours (adjusted odds ratio [AOR], 1.42 [95% CI, 1.06-1.90]), lower severity risk score (AOR, 1.70 [95% CI, 1.25-2.31]), admission to a specialty service categorized as other (eg, hepatology, gastroenterology, and kidney) (AOR, 2.14 [95% CI, 1.35-3.40]), transfer for care continuity (AOR, 2.35 [95% CI, 1.45-3.79]) or for patient or family preference (AOR, 26.60 [95% CI, 12.11-58.45]). Secondary transfer reasons involving need for specialized procedural (AOR, 0.38 [95% CI, 0.23-0.63]) or nonprocedural (AOR, 0.39 [95% CI, 0.24-0.63]) care were associated with lower odds of avoidable transfer.

In this cross-sectional study of 1560 medical patients who underwent IHT, nearly one-quarter of the transfers were potentially avoidable. Many could have been managed at the transferring hospital or through alternatives such as teleconsultation, suggesting opportunities to reduce avoidable transfers. Future efforts should explore telehealth-based alternatives and approaches targeting lower-acuity patients and nonmedical drivers of transfer while maintaining patient-centered care.