Interhospital transfers are complicated and present numerous safety challenges. In this study, outcomes of patients admitted to one hospital via the emergency department (ED) and via a transfer center (from outpatient, another hospital, or another ED) were compared. In both matched and unmatched cohorts, patients admitted via the referral center had longer length of stay and higher mortality and readmission rates. In addition, the transfer cohort had a higher utilization of palliative care services.