The Role of Telemedicine on Interhospital Transfer Outcomes : A Systematic Review.

Abstract

Interhospital transfers are essential to ensure access to appropriate levels of care, yet many transfers are potentially avoidable, leading to unnecessary resource use and patient burden. To determine the association between telemedicine and interhospital transfer rates among patients considered for an interhospital transfer. Five databases were searched from database inception to 20 January 2026. Studies including patients considered for transfer between hospitals, studies comparing telemedicine with usual care, and studies reporting interhospital transfers rates. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was interhospital transfer rate; the secondary outcome was death. Grouping by patient population, clinical indication for transfer, setting, and intervention characteristic was done. Thirty-three studies representing 609 188 patients were included. Given substantial clinical and methodological heterogeneity, a structured narrative synthesis was done. Telemedicine was commonly associated with lower transfer rates in adult (13 of 17 adult only studies) and pediatric (4 of 5 studies) populations, across clinical indication for transfer (medical [9 of 14 studies] versus surgical [6 of 7 studies] versus acute care conditions [7 of 12 studies]), and rural (9 of 16 studies) and urban (9 of 10 studies) settings. Variation in the transfer rate changes was driven by differences in confounder adjustment, comparator definitions, and study design. Telemedicine was associated with lower or unchanged mortality in most studies that assessed mortality (15 of 17 studies). Included studies were mostly observational with risk for confounding, with high heterogeneity driven by variability in study populations, telemedicine models, comparator groups, clinical contexts, and methodological approaches. Telemedicine may support appropriate triage and reduce potentially avoidable interhospital transfers, with no adverse association on mortality, contributing to safe and efficient transfer decision making. None. (PROSPERO: CRD42023493486).