title: The chest pain emergency department and the outpatient chest pain evaluation center: revolution or evolution?
abstract: OBJECTIVE
  To define the chest pain emergency department and the outpatient chest pain evaluation center, and to critically analyze the costs and benefits of modifying or replacing the current system of hospital-based evaluation of chest pain patients with these new systems.
  
  
  METHODS
  Peer-reviewed articles, published letters, book chapters, national health statistics, and personal communications were used. Sources were limited to those describing experiences in the United States.
  
  
  METHODS
  Relevant sources from the United States were reviewed.
  
  
  RESULTS
  The widespread adoption of the chest pain ED as currently configured would result in increased health care expenditures of between $389 million and $3.9 billion. It is estimated that this expenditure might save a maximum of 1,029 additional lives per year, at a cost of between $378,000 and $3.78 million per life saved.
  
  
  CONCLUSIONS
  Current hospital-based systems for evaluating patients presenting with symptoms suggestive of acute ischemic heart disease need improvement. Modification of the system of initial patient evaluation should occur as an evolutionary change to the current ED system. Adoption of a formal system of chest pain EDs represents an inefficient use of resources. Design and implementation of patient education programs about ischemic heart disease should be a public sector responsibility. More research is needed before the proper role of the outpatient chest pain evaluation center can be evaluated.
authors.affiliation: Department of Emergency Medicine, George Washington University, Washington, DC.
authors.forename: R
authors.initials: R
authors.lastname: Shesser
authors.forename: M
authors.initials: M
authors.lastname: Smith
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D002201:Capital Expenditures; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D017721:Hospital Costs; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy; D015912:Thrombolytic Therapy; D014481:United States