Nearly 1 in 4 Medical Interhospital Transfers Potentially Avoidable

A cross-sectional study published in JAMA Network Open found that about one-quarter of interhospital transfers (IHTs) of adult medical inpatients to 16 US referral hospitals were potentially avoidable.

Investigators sought to determine how often IHT among hospitalized medical patients is potentially avoidable and which characteristics are associated with it. They defined a potentially avoidable transfer as one in which care needs could have been met through an alternative to transfer, could have been managed at the transferring hospital, or did not require urgent management during that hospitalization.

The study included 1560 randomly selected adult medical patients transferred between March 2022 and October 2023 (mean age, 59.2 years; 57.8% male). Two trained adjudicators independently rated each transfer's appropriateness and reached consensus. Overall, 374 transfers (24.0%) were classified as potentially avoidable. Among these, 66.8% involved a care need that could have been managed at the transferring hospital, and 49.7% could have been managed with at least 1 alternative to transfer under current systems of care. Teleconsultation was the most commonly identified alternative.

In multivariable analysis, transfer for patient or family preference was associated with higher odds of avoidable transfer, although the confidence interval was wide (adjusted odds ratio [AOR], 26.60; 95% CI, 12.11-58.45). Transfer for care continuity (AOR, 2.35), a lower severity risk score (AOR, 1.70), admission to a specialty service categorized as other (e.g., hepatology, gastroenterology, and kidney) (AOR, 2.14), and a delay of more than 24 hours between acceptance for transfer and arrival (AOR, 1.42) were also associated with greater odds. Secondary transfer reasons involving a need for specialized procedural or nonprocedural care were associated with lower odds.

The authors noted that the retrospective design carried a risk of hindsight bias, that clinicians at receiving hospitals made all appropriateness ratings, and that including only 16 referral hospitals may limit generalizability. They concluded that future efforts should explore telehealth-based alternatives and approaches targeting lower-acuity patients and nonmedical drivers of transfer while maintaining patient-centered care.

Source: Mueller SK, Singleton S, Mutte M, et al. Prevalence and characteristics of potentially avoidable interhospital transfers. JAMA Netw Open. 2026;9(9):e2636614. doi:10.1001/jamanetworkopen.2026.36614