The incomplete infrastructure for interhospital patient transfer.
OBJECTIVE
Interhospital transfer of critically ill patients is a common part of their care. This article sought to review the data on the current patterns of use of interhospital transfer and identify systematic barriers to optimal integration of transfer as a mechanism for improving patient outcomes and value of care.


METHODS
Narrative review of medical and organizational literature.


CONCLUSIONS
Interhospital transfer of patients is common, but not optimized to improve patient outcomes. Although there is a wide variability in quality among hospitals of nominally the same capability, patients are not consistently transferred to the highest quality nearby hospital. Instead, transfer destinations are selected by organizational routines or non-patient-centered organizational priorities. Accomplishing a transfer is often quite difficult for sending hospitals. But once a transfer destination is successfully found, the mechanics of interhospital transfer now appear quite safe.


CONCLUSIONS
Important technological advances now make it possible to identify nearby hospitals best able to help critically ill patients, and to successfully transfer patients to those hospitals. However, organizational structures have not yet developed to insure that patients are optimally routed, resulting in potentially significant excess mortality.
Department of Medicine, University of Michigan, Center for Clinical Management Research, Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, MI, USA. tiwashyn@umich.edu
Theodore J
TJ
Iwashyna
D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000628:therapy; D006739:Hospital Administration; D006801:Humans; D007373:Interinstitutional Relations; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000458:organization & administration*; D014481:United States