Telemedicine may reduce interhospital transfers without increasing mortality

1. In this systematic review and meta-analysis, telemedicine was associated with lower rates of interhospital transfer among both pediatric and adult patients.

2. Across most studies, telemedicine reduced or did not change mortality rates, supporting its safety as an alternative to routine interhospital transfer.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Although only a minority of hospitalized patients are transferred between acute care hospitals, some transfers may be avoidable. Telemedicine, which enables clinicians to provide care and consultation across locations, has the potential to improve transfer decision-making, although existing evidence has been mixed. This systematic review of 33 studies evaluated whether telemedicine reduces interhospital transfers among pediatric and adult patients. Most studies found that telemedicine was associated with fewer interhospital transfers in both pediatric and adult populations. Among adult patients, mortality was generally unchanged with telemedicine, while among pediatric patients it was either reduced or unchanged. Across studies involving medical, surgical, and acute care conditions, telemedicine consistently reduced transfer rates without increasing mortality. Similar findings were observed in both rural and urban hospitals. Video-based telemedicine consultations that included direct patient assessment were also associated with fewer transfers and similar or improved mortality outcomes, even after adjustment for potential confounders. The findings should be interpreted in light of several limitations. The included studies were heterogeneous with respect to telemedicine interventions, patient populations, and clinical settings, precluding meta-analysis and requiring a narrative synthesis. In addition, most studies were conducted in the United States, and nearly all were observational, limiting causal inference and generalizability. Nevertheless, this review suggests that telemedicine may safely reduce potentially avoidable interhospital transfers across a range of clinical settings without increasing patient mortality, supporting its role as a strategy to improve access to specialty care while reducing unnecessary transfers.

Click to read this study in AIM

Relevant Reading: ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration

In-Depth [systematic review and meta-analysis]: This systematic review evaluated the effect of telemedicine on interhospital transfers and mortality among pediatric and adult patients. Ovid MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from database inception to January 20, 2026. Eligible studies compared telemedicine with usual care for interhospital transfer decisions and reported transfer outcomes. Telemedicine was defined as communication between healthcare professionals at different institutions. The primary outcome was interhospital transfer, and the secondary outcome was mortality. Thirty-three studies involving 609,188 patients were included, with 262,527 (43.1%) receiving a telemedicine intervention and 346,661 (56.9%) receiving usual care. Most studies were retrospective cohort studies (26/33) and conducted in the United States (23/33). Overall, 22 of 33 studies reported reduced interhospital transfer rates with telemedicine, with absolute differences ranging from a 92.8% reduction to a 79.3% increase. Among the nine studies adjusting for potential confounders, seven reported lower transfer rates and two found no difference. Seventeen studies evaluated mortality. Six reported lower mortality with telemedicine, while nine found no difference. Among adult-only studies, 13 of 17 reported reduced transfer rates, whereas four of five pediatric studies demonstrated fewer transfers with telemedicine. Mortality was reduced or unchanged in both adult and pediatric populations. Telemedicine was associated with lower transfer rates across medical (9/14 studies), surgical (6/7 studies), and acute care (7/12 studies) conditions, with mortality generally reduced or unchanged. Similar findings were observed in rural hospitals (9/16 studies reporting fewer transfers) and urban hospitals (9/10 studies). Among the 24 studies using video-based telemedicine with direct patient assessment, 17 reported fewer interhospital transfers, while five of 11 studies assessing mortality reported reductions and four found no difference. Overall, this systematic review suggests that telemedicine is associated with fewer interhospital transfers across diverse patient populations and clinical settings without increasing mortality, supporting its use to reduce potentially avoidable transfers while maintaining patient safety.

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