Transfer delays can occur at multiple levels and for Efforts are needed to reduce the time delay between arrival to and transfer from a non PCI-capable hos- pital (ie, door-in door-out). Among a subset of 14821 patients in the NCDR ACTION GWTG registry, the median door-in door-out time was 68 minutes (interquartile range, 43 to 120 minutes). A door-in door-out time 30 minutes, achieved in only 11% of patients, was associated with shorter delays to reperfusion and a lower in-hospital mortality rate.129 Because estimation of treatment times for patients can be inaccurate, the decision to transfer for primary PCI should be based on actual, historical times achieved within the regional system, with quality assurance programs to ensure that such goals are consistently met. A reasonable goal would be that 90% of patients should meet the 120-minute time-to-treatment stan- dard to achieve performance standards. Several triage and transfer strategies have been tested and are discussed further in Section 5.3. The term facilitated PCI was used previously to describe a strategy of full- or half-dose fibrinolysis, with or without administration of a glycoprotein (GP) IIb/IIIa receptor antagonist, with immediate transfer for planned PCI within 90 to 120 minutes. Two large stud- ies failed to show a net clinical benefit with this strategy.130,131 The term rescue PCI refers to the transfer for PCI of patients who demonstrate findings of failed reperfusion with fibrino- The term pharmacoinvasive strategy refers to the administration of fibrinolytic therapy either in the prehospital setting or at a non PCI-capable hospital, followed by immedi- ate transfer to a PCI-capable hospital for early coronary angi- ography and PCI when appropriate. 