Objective To investigate the risk factors and nursing strategies for clinical deterioration during intrahospital transport of critically ill patients in the emergency department. Methods A retrospective study was conducted in critically ill patients admitted to the emergency department from March to December 2023 who required intrahospital transport for diagnostic and therapeutic purposes. Data were collected including risk scores prior to transport, patients'clinical information, qualification of the transporting nurses, preparation time, final care time, and the National Early Warning Scoring (NEWS) score indicating clinical deterioration during transport. Multivariate Logistic regression analysis was performed to identify the risk factors influencing clinical deterioration during intrahospital transport of critically ill patients. Results Among 839 critically ill patients transported within the hospital, the clinical deterioration rate was 28.37%. Multivariate Logistic regression analysis revealed that transport duration ranging from 21 to 25 minutes were significantly associated with clinical deterioration (β=0.133, P=0.027). Patients'symptoms including body part injury, head injury, burns, poisoning (β=0.670, P=0.030), respiratory distress/spasm (β=0.919, P < 0.001), shock/arrhythmia/chest pain/hemorrhage (β=1.134, P < 0.001), coma/changes in mental status/fainting (β=1.343, P < 0.001), and cardiac arrest (β=2.251, P < 0.001) were highly correlated with clinical deterioration. Patients with unstable conditions (β=1.689, P < 0.001), those with pre-transport risk scores of 8 or higher (β=0.625, P < 0.001), and those transported by non-dedicated transport nurses (β=0.495, P < 0.008) were significantly related to increased risk of clinical deterioration. Conclusion The incidence of clinical deterioration during intrahospital transport of critically ill patients is relatively high. Diseases involving the circulatory, respiratory, and nervous systems, unstable clinical conditions, high pre-transport risk scores, transport duration of 21 to 25 minutes, and presence of transport by non-specialized nurses are all associated with higher rates of clinical deterioration.