Outcome of critically ill patients undergoing interhospital transfer

Objective: To quantify the morbidity and mortality associated with acute interhospital transfer of critically ill patients requiring intensive care (ICU) services. Design: Three-year (1 July 1996 - 30 June 1999) retrospective case-control study based on review of patients' medical records. Setting: Metropolitan hospitals in Melbourne, Victoria. Participants: 73 (of 75) consecutive, critically ill patients from one metropolitan teaching hospital who were transferred to other hospitals because ICU services were not available. Outcome measures: Primary endpoints included inhospital mortality and length of stay in ICU and hospital. Secondary endpoints included time from study entry to ICU admission and the change in predicted mortality risk after resuscitation and transfer to ICU (inter- or intrahospital transfer). Results: The Transfer Group experienced a significant delay in admission to ICU (5.0 [4.0-6.0] v 3.0 [2.0-5.5] hours; P=0.001), and a longer stay in ICU (48 [33-111] v 44 [25-78] hours; P=0.04), and hospital (10 [3-14] v 6 [3-13] days; P=0.02). Hospital mortality in the Transfer Group (24.7%) was not statistically different from that in;the Control Group (17.8%; P=0.41; OR, 1.5; 95% CI, 0.68-3.4). Conclusion: Acute interhospital transfer is associated with a delay in ICU admission and a longer:stay in ICU and hospital, but no statistically significant difference in mortality. A study of over 300 patient transfers would be required to clarify the morbidity and mortality risk of acute interhospital transfer.