Do emergency department transfers require specialist consultation or admission?

When emergency department (ED) patients require a higher level of care, transferring patients for specialized services to another ED may be needed. Previous studies have characterized risks and cost factors involved with transfers; however, few have evaluated the appropriateness of transfers. The objective of this study was to determine if a specialty consultation or admission was required for ED-to-ED transfers. This was a retrospective cohort of all adult patients aged 18 and older who presented one of 17 EDs between January 1, 2018, and December 31, 2020, and were transferred to another ED within the healthcare system. Categorical variables are presented as frequencies and percentages. Continuous variables are presented as mean and standard deviations or median and quartiles. Multiple logistic regression was utilized to determine if the variables collected were predictive of hospital admission. A total of 7486 encounters were included in the study. The mean age of participants was 54. Most patients were white (76.5%), male (50.6%), and had private insurance (39.0%). At the receiving ED, 64.0% (n ​= ​4750) received a specialty consult, and 61.3% (n ​= ​4549) were admitted to inpatient services. A total of 1430 (19.3%) patients did not receive a specialty consult and were discharged from the ED. The majority all ED-to-ED transfers involved a specialty consultation, and 61.3% of patients transferred were admitted to the hospital. Further research to determine why patients did not require specialty consultation or admission may help reduce unnecessary transfers.