Interhospital stroke transfers have increased substantially in the last few decades, prompting a need to minimize unnecessary transfers and develop more effective secondary triage. 

We conducted a retrospective observational study using data on statewide inpatient discharges in California, Florida, and New York, 2018-2020. Our study included adults transferred from an acute care hospital or emergency department and subsequently admitted to another acute care hospital with primary diagnosis of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). The main outcome was “short stay” hospitalization following interhospital transfer, defined as discharge in ≤ 48 hours after arrival. We examined patient demographics, procedures performed, hospital characteristics, and disposition associated with short stay after transfer.  

Among 44,269 hospitalizations following interhospital transfer (63% AIS, 24% ICH, 14% SAH), there were 10,034 short stay hospitalizations (23% of transfers). ICH or SAH diagnosis, Medicaid, more comorbidities, and Asian or Pacific Islander, Black, and Hispanic race or ethnicity were associated with lower odds of short stay. Older age and rural location were associated with shorter hospital stays (i.e., ≤ 48 hours). Neurosurgical interventions were associated with longer hospital stays whereas thrombolytic administration was associated with short stays. Increased annual hospital stroke volume had a decreased likelihood of short stay hospitalization; however, teaching hospitals and hospitals with neurological services had greater odds of short stay hospitalization. Short stay hospitalizations predominantly resulted in home discharge (63%), followed by death or discharge to hospice (23%). Conversely, discharge destinations after longer stay hospitalizations were inpatient rehabilitation (48%) and home (35%).

Multiple factors are associated with short stay hospitalizations for acute stroke following interhospital transfer. The large proportion of hospitalizations discharged to home or death/hospice suggests some transfers may be unnecessary.