748: Increased Mortality in Interhospital Transfer Due to Emtala: A Retrospective Cohort Study

Introduction: The Emergency Medical Treatment and Labor Act (EMTALA) enacted in 1986, aimed to address discriminatory emergency treatment of uninsured patients. Since then, interhospital transfer of critically ill patients has become more common in the United States. However, little research has evaluated the effect of EMTALA-related transfers on patient mortality. This study aims to assess the effect of interhospital transfer due to EMTALA on mortality among critically ill patients. Methods: A retrospective analysis of all ICU admissions from 2022 to 2024 from a single quaternary medical center was performed. Patients were categorized into four cohorts: all transfers, EMTALA transfers, non-EMTALA transfers, and non-transfers. A multivariate analysis was conducted to assess mortality differences between the separate cohorts controlling for age, sex, race/ethnicity, APACHE IV hospital mortality score at 24 hours of admission, and insurance status. Results: 604 non-transfers and 552 transfers were included in the comparative analysis. The transfer group was further divided into EMTALA transfer (n=313) and non-EMTALA transfer (n=239) subgroups. After adjustment, patients who were transferred had 75% higher odds of death compared to non-transferred patients (OR 1.75, 95% CI, 1.23-2.49, p= 0.002). EMTALA transfers had 58% higher odds of death compared to non-transfers (OR 1.58, 95% CI, 1.03-2.43, p= 0.035) and non-EMTALA transfers had over a twofold increase in odds of death compared to non-transfer patients (OR 2.05, 95% CI, 1.35-3.12, p= < 0.001). When mortality outcomes were compared between EMTALA transfer and non-EMTALA transfer subgroups, there was no significant difference (OR 1.42, CI 95%, 0.91- 2.22, p= 0.12). Conclusions: To our knowledge, this is the first study to assess mortality outcomes of critically ill EMTALA transfers while adjusting for severity of illness. The practice of interhospital transfer of critically ill patients, whether EMTALA related or not, was associated with significantly increased risk of mortality compared to patients who were not transferred. While transferring EMTALA patients was associated with an increased odds of death within our sample, this may reflect geographic-specific outcomes.