Mortality of patients transferred to a tertiary care hospital

BACKGROUND Seriously ill patients are often transferred from community hospitals to tertiary care hospitals.

OBJECTIVES To review the numbers, sources, and outcomes of patients transferred to the Cleveland Clinic Hospital from 1989 through 1992.

METHODS Retrospective analysis.

RESULTS Compared with the Cleveland Clinic’s overall hospital mortality rate of 3.09% (3760 of 121 014 patients) during this period, the mortality rate among transferred patients was 8.26% (1092 of 13 226 patients). Although transferred patients accounted for only 10.9% of the total admissions, they represented 29.0% of the deaths. Transfers from other hospitals in the Cleve-land Health Quality Choice (HQC) program, a community-wide quality-assessment project, increased 40.2% in 1992 (during the initial data collection period for the HQC program), while those from non-HQC hospitals increased only 0.9%.

CONCLUSIONS Patients transferred to a tertiary care hospital from other acute care hospitals have a 2.7-fold greater chance of dying in the hospital than nontransferred patients. Public scrutiny of quality may increase the likelihood of transfer of seriously ill patients to tertiary care centers.