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Chest pain evaluation units: an idea whose time has come.

In this issue ofThe Journal, Roberts et al 1 present the results of a randomized controlled clinical trial comparing the cost for evaluation of patients with chest pain in an emergency department—based accelerated diagnostic protocol (ADP) vs traditional hospitalization. This article, despite its limitations, addresses some of the controversies in the expanding literature support for emergency department—based ADPs and chest pain evaluation units (CPEUs) as feasible, safe, and effective alternatives to hospital admission for patients with chest pain. Approximately 15% of emergency departments in the United States have established CPEUs. This percentage has been increasing as managed care programs and diminishing resources dictate the need for cost-effective approaches to the care of patients with chest pain. The development of CPEUs for the evaluation of patients with chest pain makes intuitive sense. Patients with possible acute coronary syndrome (ACS) remain a significant challenge for emergency physicians. The inadvertent release of 2%