Transferring older patients between hospitals was linked to more deaths and readmissions

Design

Retrospective national database analysis

Population

11.8 million weighted hospitalisations of adults aged 65 or over (2019 US NRD)

Primary outcome

Readmission and in-hospital mortality

Effect

Mortality aOR 1.91 (95% CI 1.81 to 2.02); 30-day readmission aOR 1.29 (1.19 to 1.40)

A Journal of the American Geriatrics Society analysis used the 2019 US National Readmissions Database to compare adults aged 65 or over who were transferred between acute hospitals with those who were not. Of 11.8 million weighted admissions, 0.9% involved a transfer.

After adjustment for mortality and readmission risk, admitting service, insurer, procedures and other factors, transfer was associated with higher in-hospital mortality (adjusted OR 1.91, 95% CI 1.81 to 2.02) and higher readmission (adjusted OR 1.09). In a sensitivity analysis focused on 30-day readmission, the odds were 29% higher (adjusted OR 1.29, 1.19 to 1.40).

Transferred patients are usually sicker in ways administrative data cannot capture, so much of this excess risk may reflect illness severity rather than the transfer itself. The useful clinical point is that a transfer is a transition of care with its own risks for an older person — delirium, lost information, medication errors — and deserves the same attention as discharge.

• Treat an interhospital transfer of an older patient as a high-risk care transition.
• Send a complete medication list, goals-of-care discussion and baseline cognitive and functional status with every transfer.
• Consider whether the transfer serves the patient's stated goals, especially near the end of life.
• Screen for delirium on arrival after any transfer.
• Arrange follow-up planning at discharge, given the higher readmission risk.

Why it matters

Transfers are often treated as logistics, but for older patients they carry measurable risk.

Don't overread it

This observational study cannot separate the effect of transfer from the severity of illness that prompted it.

The statistics, in plain English

An adjusted odds ratio of 1.91 means the odds of dying in hospital were nearly twice as high after transfer, after accounting for the measured risk factors. Unmeasured severity could explain part of this.

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