SHM Converge Scientific Abstract ePoster Gallery-Early Clinical Deterioration After Interhospital Transfer and Its Impact on Patient Outcomes

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This retrospective cohort study examined adult medical interhospital transfers at Virginia Commonwealth University Health System from January 2024 to August 2025 to assess whether early clinical deterioration after transfer predicts worse outcomes. The main exposure was escalation to the ICU within 24 hours of arrival to acute or stepdown care, and the primary outcome was in-hospital mortality.<br /><br />Among 2,806 transfers, only 4% required ICU escalation within the first 24 hours. Overall, patients transferred directly to the ICU had a mortality rate of 23%, while those escalated to the ICU within 24 hours had a significantly higher mortality rate of 38% (p = 0.006), representing about a 65% relative increase in death risk. Median ICU length of stay was also longer in the early-escalation group (10 days versus 6 days), though this difference was not statistically significant (p = 0.11).<br /><br />Baseline demographic characteristics were similar across transfer groups, suggesting the worse outcomes were not explained by obvious differences in age, sex, or race. The broader transfer population also had substantial mortality across levels of care: 22.5% for direct ICU transfers, 9.7% for stepdown transfers, and 4.5% for general floor transfers.<br /><br />The authors conclude that interhospital transfers carry high risk, and that patients who deteriorate soon after transfer represent a particularly vulnerable subgroup. They emphasize the need for better pre-transfer risk assessment, improved triage decisions, and careful evaluation of the benefits and risks of transfer. Further quality improvement and research are needed to enhance safety during the first 24 hours after interhospital transfer.

Asset Subtitle

Ginu Kurian

Meta Tag

Author List Ginu Kurian, Jason Pecorella, Matthew Ambrosio, Matthew Russell, Michael Moseley, Stephen Biederman

Category Research

Concept Hospital Transfer

Concept Mortality

Concept ICU

Concept Early ICU Escalation

Concept Inpatient Mortality

Distinguished Finalist

Presenter Organization VCU Health

Presenting Author Ginu Kurian

Track Quality Improvement

Keywords

interhospital transfer

early clinical deterioration

ICU escalation

in-hospital mortality

retrospective cohort study

adult medical patients

acute care

stepdown care

risk stratification

patient transfer safety

Hospital Transfer

Mortality

ICU

Early ICU Escalation

Inpatient Mortality