Abstract Rationale Sepsis remains a leading cause of in-hospital mortality and healthcare expenditure in the U.S. Timely recognition and evidence-based care are critical for improving outcomes. Interhospital transfer, especially from community or rural settings to high-volume centers, is a common strategy but may delay treatment. This qualitative systematic review assesses the impact of hospital sepsis case volume on outcomes, the role of interhospital transfer, and the influence of timely care delivery on patient outcomes. Methods A comprehensive literature search was conducted across MEDLINE, Embase, CINAHL, Scopus, and ClinicalTrials.gov (last updated February 2025), identifying studies related to sepsis, interhospital transfer, case volume, and clinical outcomes. Four independent reviewers screened studies using predefined inclusion criteria. Data extraction and qualitative synthesis were performed, with study quality assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results From 2896 records, 24 distinct studies were included: 22 retrospective cohorts and 2 cross-sectional studies. 21/24 studies were rated as good quality on the NHBLI quality assessment tool, and the remaining 3 were rated as fair. 11 of these studies directly evaluated the impact of sepsis case volume, including several large nationwide cohorts in multiple countries. Most found that higher sepsis case volume was associated with reduced mortality and improved secondary outcomes. However, findings regarding interhospital transfer and timing of sepsis care were mixed. Some studies found higher mortality and cost associated with transfer, particularly when early resuscitation and appropriate antibiotic administration were delayed. One group of researchers also found across several studies that socioeconomic and geographic factors influenced the decision to transfer adult sepsis patients, and that 39% of pediatric sepsis patients who were transferred met the criteria for what they defined as potentially avoidable transfers. Conclusion Treatment at higher sepsis case volume centers is consistently associated with improved outcomes, but the benefits of interhospital transfer are less clear and may depend on illness severity and early care. Given there is a relative paucity of studies on the topic, future multi-center studies are needed to clarify optimal transfer practices and address disparities in access to timely, evidence-based sepsis care. These results continue to underscore the importance of standardizing transfer criteria and ensuring early sepsis bundle activation prior to transfer. This abstract is funded by: None
Bockelman et al. (2026) studied this question.