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Purpose-Interhospital critical care transfers are common, yet few studies address the underlying reasons for transfers. We examined clinician and patient/surrogateperceptions about interhospital transfers and assessed their agreement on these transfers. Results-62 hospitals transferred 138 patients during the study period. Response rates varied among stakeholders (accepting physician: 90%, referring physicians: 20%, patients/surrogates: 33%). All three groups frequently endorsed quality of care and need for a specific test/procedure as important. Referring hospital reputation and quality were rarely endorsed. Accepting physicians and patients/surrogates substantially agreed on the need for a specific test (kappa=0.70) and increased survival (kappa=0.78), but otherwise had fair to poor agreement. Referring physicians and patients/surrogates rarely agreed and sometimes disagreed greater than expected by chance (kappa <0). Physician pairs strongly agreed on the importance of accepting hospital experience (kappa=0.96), but agreed less on patient satisfaction at the referring hospital (kappa=0.37) and referring hospital reputation (kappa=0.35).Conclusions-Stakeholders do not always agree on the reasons for critical care transfers. Efforts to improve communication are warranted to insure informed patient choices.

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