Interhospital transfers of the critically ill: Time spent at referring institutions influences survival

J Crit Care. 2017 Jun:39:1-5. doi: 10.1016/j.jcrc.2016.12.016. Epub 2016 Dec 24.


Objective: To determine if the length of stay at a referring institution intensive care unit (ICU) before transfer to a tertiary/quaternary care facility is a risk factor for mortality.

Design: We performed a retrospective chart review of patients transferred to our ICU from referring institution ICUs over a 3-year period. Logistical regression analysis was performed to determine which factors were independently associated with increased mortality. The primary outcomes were ICU and hospital mortality.

Main results: A total of 1248 patients were included in our study. Length of stay at the referring institution was an independent risk factor for both ICU and hospital mortality (P<.0001), with increasing lengths of stay correlating with increased mortality. Each additional day at the referring institution was associated with a 1.04 increase in likelihood of ICU mortality (95% confidence interval, 1.02-1.06; P =0.001) and a 1.029 (95% confidence interval, 1.01-1.05; P .005) increase in likelihood of hospital mortality.

Conclusions: Length of stay at the referring institution before transfer is a risk factor for worse outcomes, with longer stays associated with increased likelihood of mortality. Further studies delineating which factors most affect length of stay at referring institutions, though a difficult task, should be pursued.

Keywords: Interhospital transfer.

MeSH terms

  • Critical Illness / mortality*
  • Female
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Length of Stay*
  • Male
  • Middle Aged
  • Ohio
  • Outcome Assessment, Health Care*
  • Patient Transfer*
  • Referral and Consultation*
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors