Background:

Interhospital transfers (IHTs) to academic medical centers may benefit patients by providing access to a higher level of care or continuity with a familiar care team. However, IHTs may also include the risks of transportation and long‐distance handoffs for patients with complex or worsening medical problems. Hospitalists and general internists often serve as the accepting provider for IHT patients and may be able to mitigate these risks. However, little is currently known about the characteristics and outcomes of these patients. To focus quality improvement and patient safety work around this transition, we sought to describe the outcomes of this population by drawing comparisons with acute care patients admitted from the emergency department (ED).

Methods:

We analyzed records from the University HealthSystem Consortium (UHC) Clinical Data Base collected from April 1, 2011, through March 31, 2012. We included all inpatients ≥ 18 years old whose admitting attending physician specialty designation was either “general internal medicine” or “hospitalist.” The IHT population was defined by admission source: “transfer from another hospital.” The ED population was defined by admission to “inpatient” status from any source other than an inpatient setting or ambulatory surgery center. Groups were compared with descriptive statistics and a chi‐square test for categorical variables or t test for continuous variables.

Results:

Hospitalists and internists at UHC hospitals admitted 79,719 IHT patients and 806,947 ED patients over the 1‐year period. The IHT population was younger (mean age, 60.1 vs. 62.0 years), more likely to be male (52% vs. 47%), and less likely to be black (12% vs. 26%) — all comparisons P < 0.001. IHT patients' payer was less likely to be Medicare or Medicaid and more likely be a commercial insurer (72% vs. 78% and 27% vs. 21%, respectively; all P < 0.001). IHT admissions were more likely to occur between 4 pm and midnight (56% vs. 49%, P < 0.001). Average length of stay for IHT patients was longer (7.9 ± 13.3 vs. 5.0 ± 6.9 days, P < 0.001) and included more ICU days (1.7 ± 5.1 vs. 0.6 ± 2.4 days, P < 0.001). IHT patients were less likely to be discharged home (53% vs. 61%, P < 0.001). IHT patients had higher in‐hospital mortality (4.0% vs. 1.8%, P < 0.001) and costs ($20,135 ± $34,788 vs. $11,041 ± 16,979, P < 0.001).

Conclusions:

IHT patients arrive later in the day, stay longer, spend more time in the ICU, are more likely to die in the hospital, and are more costly than the population being admitted from the ED. It is unclear what proportion of these findings can be attributed to the transition between hospitals and what proportion are a result of the medical conditions associated with IHTs. Future work should focus on risk‐adjusting these findings and developing systematic tools to mitigate the risks of the IHT.