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Guided transfer of critically ill patients: where patients are transferred can be an informed choice

Iwashyna, Theodore J.a,b; Courey, Anthony J.a

Current Opinion in Critical Care: December 2011 - Volume 17 - Issue 6 - p 641–647
doi: 10.1097/MCC.0b013e32834b3e55
Ethical, legal and organizational issues in the ICU: Edited by Jeremy M. Kahn

Purpose of review: 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.

Recent findings: 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.

Summary: 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.

aDepartment of Medicine, University of Michigan

bCenter for Clinical Management Research, Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, Michigan, USA

Correspondence to Theodore J. Iwashyna, MD, PhD, 3a23 300 NIB, SPC 5419, 300 North Ingalls, Ann Arbor, MI 48109-5419, USATel: +1 734 936 5047; fax: +1 734 936 5048; e-mail: tiwashyn@umich.edu

© 2011 Lippincott Williams & Wilkins, Inc.