Interfacility transfers to the emergency department via emergency medical services in the United States: A nationwide descriptive study and trend analysis

Authors

• Gregory A Peters, Harvard Medical School, USA
• Kian D Samadian, Harvard Medical School, USA
• Saba Ambreen Awan, Aga Khan UniversityFollow
• Anjali J Misra, Harvard Medical School, USA
• Kira G Chandran, Harvard Medical School, USA
• Calvin K Huang, Harvard Medical School, USA
• Joshua J Baugh, Harvard Medical School, USA
• Rebecca E Cash, Harvard Medical School, USA
• Scott A Goldberg, Harvard Medical School, USA

Document Type

Article

Department

Medicine; Internal Medicine

Abstract

Objective: We hypothesized: (1) the burden of emergency department (ED) resource utilization for interfacility transfer (IFT) patients is greater than for other ED patients, and (2) national rates of IFT to the ED have increased over time.
Methods: We completed a retrospective cohort analysis using a nationally representative sample of ED visits during 2014-2022 and stratified by whether the patient arrived via IFT with emergency medical services (EMS). We described and compared patient characteristics and measures of emergency resource utilization between groups using appropriate survey sampling weights. We then assessed national trends in the annual proportion of ED visits arriving via IFT using a logistic regression model with three-year estimates.
Results: A weighted estimate of 1,213,596,152 ED visits (roughly 136 M annually) was included in this analysis. There were 11,802,738 (1.0%) ED visits that arrived via IFT, yielding an annual mean of 1.3 M per year. IFT patients were more often triaged ESI 1 and 2; had shorter wait times to be seen; received more diagnostic tests, medications, and procedures in the ED; and were more often hospitalized. Using three-year study periods, the proportion of IFT among ED visits increased by 15% during 2017-2019 and by 35% during 2020-2022 relative to the baseline period during 2014-2016.
Conclusions: Our findings support the hypotheses that IFT patients consume a significantly higher volume of ED resources, and that the proportion of ED visits arriving via IFT has increased over time. Tertiary center EDs and EMS agencies should invest in improved preparedness for ED-ED IFT patients.

Comments

Issue no is not provided by author/publisher

Publication (Name of Journal)

The American journal of emergency medicine

DOI

10.1016/j.ajem.2026.04.025

Recommended Citation

Peters, G., Samadian, K., Awan, S., Misra, A., Chandran, K., Huang, C., Baugh, J., Cash, R., Goldberg, S. (2026). Interfacility transfers to the emergency department via emergency medical services in the United States: A nationwide descriptive study and trend analysis. The American journal of emergency medicine, 106, 24-29.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_intern_med/299