title: Guided transfer of critically ill patients:  where patients are transferred can be an informed choice.
abstract: OBJECTIVE
  Given increasingly scarce healthcare resources and highly differentiated hospitals, with growing demand for critical care, interhospital transfer is an essential part of the care of many patients. The purpose of this review is to examine the extent to which hospital quality is considered when transferring critically ill patients, and to examine the potential benefits to patients of a strategy that incorporates objective quality data into referral patterns.
  
  
  RESULTS
  Interhospital transfer of critically ill patients is now common and safe. Although extensive research has focused on which patients should be transferred and when they should be transferred, recent study has focused on where patients should be transferred. Yet, the choice of destination hospital is rarely recognized as a therapeutic choice with implications for patient outcomes. The recent public release of high-quality, risk-adjusted and reliability-adjusted outcome data for most hospitals now offers physicians an informed basis on which to choose to which destination hospital a patient should be transferred. A strategy of 'guided transfer' that integrates public quality information into critical care transfer decisions is now feasible.
  
  
  CONCLUSIONS
  Although hospitals often transfer patients, there may be substantial room for improvement in transfer patterns. Guiding transfers on the basis of objective quality information may offer substantial benefits to patients, and could be incorporated into quality improvement initiatives.
authors: Department of Medicine, University of Michigan, Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, Michigan, USA. tiwashyn@umich.edu
authors: Theodore J
authors: TJ
authors: Iwashyna
authors: Anthony J
authors: AJ
authors: Courey
mesh_terms: D003422:Critical Care / Q000941:ethics*; D016638:Critical Illness; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007362:Intensive Care Units / Q000941:ethics*; D005791:Patient Care / Q000941:ethics; D010360:Patient Transfer / Q000941:ethics / Q000379:methods*