Safety and Feasibility of Returning Patients Early to Their Originating Centers After Transfer for Primary Percutaneous Coronary Intervention

Safety of Back‐Transfer to Local Hospitals During an Acute Care Hospitalization

“…One of the more concerning results of this report is the higher apparent mortality in back‐transferred patients, a finding that holds even when compared with PS‐matched controls. This contradicts prior data on back‐transfer in cardiology and neonatology patients …”

“…This contradicts prior data on back-transfer in cardiology and neonatology patients. [10][11][12][13][14][15] The causality of these findings is unknown. Are the patients identified as more likely to die or need more prolonged hospitalization, and thus are back-transferred to complete their care closer to home?…”

“…In Europe, backtransfer is used for patients undergoing routine coronary angiography and percutaneous coronary intervention (PCI). [10][11][12][13] This practice was found to be safe and feasible with regard to re-admission, mortality, and other complications. 13 In the United States, back-transfer has been shown to be safe for stable neonates after a hospitalization at a tertiary care neonatal intensive care unit.…”

“…The safety of back‐transfer has only been examined for limited populations. In Europe, back‐transfer is used for patients undergoing routine coronary angiography and percutaneous coronary intervention (PCI) . This practice was found to be safe and feasible with regard to re‐admission, mortality, and other complications .…”

The incomplete infrastructure for interhospital patient transfer

“…In a reverse triage model, patients no longer actively needing specialized interventions are sent from receiving hospitals to (or back to) smaller hospitals. Interesting work has been done examining how rapidly post-percutaneous coronary intervention patients can be transferred out of catheterization-capable hospitals, which might be a model for other conditions (119,120). Such work could address concerns about overtriage and "inappropriate" transfers (121)(122)(123), allowing the development of appropriateness criteria for acceptance of patients and of when patients could be safely returned to a less specialized hospital.…”