Background: Critically ill neurosurgical patients require expedient access to neurosurgical centers (NC) to improve outcome. In Ontario, many patients are initially evaluated at a non-neurosurgical center (NNC) and subsequently transferred to a NC by a provincial service using air or ground vehicles. We characterized transfers from NNC to NC for critically ill patients. Methods: A retrospective observational analysis was undertaken. The cohort included patients in Ontario with emergent and urgent neurologic pathologies who underwent transfer from a NNC to NC between January 1, 2011 and December 31, 2013. Timing, clinical, and geographic data were collected for each transfer. Results: We identified 1103 emergent/urgent transfers. The mean transfer time to a NC was 3.4hrs (SD – 3.0) and varied by the geographic region of origin. 17% of patients bypassed a closer NC during transfer to their destination NC. Transfers that bypassed a closer NC travelled further (162km vs. 477km, p<0.001), took longer (3.1hrs vs. 3.9hrs, p<0.001), and in some regions were associated with a higher risk of in-transit clinical decline (3.0% vs. 8.3%, p<0.05) when compared with transfers that ended at the closest NC. Conclusions: Transport time to a NC varied across Ontario. Transfers occasionally bypassed the nearest NC, which may reflect neurosurgical bed availability, resource limitations, or patient needs.