Understanding characteristics and trajectories of patients experiencing early death after interhospital transfer.

Abstract

Twenty- to fifty-thousand patients die annually within 72 h of interhospital transfer (early death after transfer; EDAT). The characteristics and trajectories of these patients are ill-defined. In this retrospective cohort study, we characterized EDAT at three representative major referral centers. Primary outcomes included the presence and timing of goals of care (GOC) and/or prognostic discussions. Among 190 medical patients experiencing EDAT, 95 (50.0%) were >65 years, 115 (60.5%) male, and 137 (72.6%) White; 140 (73.7%) patients traveled >50 miles from home, and 174 (91.6%) were referred for specialty care. Whereas GOC were documented pretransfer for 40 patients (21.1%) and unknown for 97 patients (51%); 152 (80.0%) had posttransfer discussions, often within 24 h of death (125; 82.2%). Transfer >50 miles was associated with death ≤24 h after transfer and with posttransfer changes in code status. Further research is needed to evaluate disparities and describe the potential burdens of transfer at end-of-life. Infrequent pretransfer discussions of GOC suggest potential targets for improvement.