Regionalized healthcare networks with centralized tertiary care centers are common in Canada. Centralizing specialist care is associated with reduced mortality and morbidity; numerous studies show improved outcomes for patients receiving care at tertiary centers [1,2]. To access centralized tertiary care, however, many patients must be transferred from outside centers or far away locations. In areas with large geography and sparse population this leads to a significant number of transfers over large distances.

In critically ill patients requiring life support, inter-facility transfers may increase harm. Consequently, the decision of who to transport and when must balance the risk of transport with the benefits derived from care in a tertiary center. Nova Scotia (NS) is a geographically broad area with 2 tertiary care adult ICUs and 10 community ICUs providing various levels of care. As such, NS provides an ideal setting to investigate the effect of inter-facility transfer on ICU patients.

To date, the literature is mixed regarding outcomes associated with the transfer of critically ill patients from community ICUs to tertiary care centers. Although some studies reveal that transfers are associated with increased morbidity and mortality [[3], [4], [5], [6], [7], [8], [9], [10]], other research documents improved or equivocal outcomes for those critically ill patients transported from community hospitals to tertiary centers [1,[11], [12], [13], [14]]. Increased resource utilization at tertiary care centers has also been found to be associated with transferred patients [3,11]. Consequently, there exists a need to better understand which patients have more favourable outcomes post-transfer. This information will enable practitioners to make the best possible transfer decisions. This study seeks to describe the demographics and outcomes of ICU patients in NS who undergo inter-facility ICU-to-ICU transfer.