title: The Association Between Medicolegal and Professional Concerns and Chest Pain Admission Rates.
abstract: OBJECTIVE
  For patients in whom acute coronary syndrome (ACS) is a concern, disposition decisions are complex and multifactorial and have traditionally been a source of considerable variation. An important factor in disposition decisions for these patients may be physician-perceived medicolegal risk and related professional concerns. The study aim was to determine, at the point of care, how much less frequently physicians report that they would admit possible ACS patients if there was either zero or a defined medicolegal risk.
  
  
  METHODS
  This was a point-of-care emergency physician survey. Research assistants approached physicians at or immediately following the moment of disposition decisions for patients who were being admitted for ACS. The primary outcome measures were the proportion of physicians reporting that patients would not have been admitted if medicolegal issues were of no concern and the proportion of physicians reporting that patients would not have been admitted if there was an "acceptable miss rate" of 1% to 2% for ACS patients.
  
  
  RESULTS
  During the 3-month study period, 576 patients were admitted to an inpatient unit or to the ED observation protocol. Physicians were approached in 271 cases, and 259 surveys were completed. When presented with hypothetical zero medicolegal risk, physicians answered that they would not have admitted the patients in 30% of cases. With a hypothetical 1% to 2% acceptable miss rate, physicians indicated that they would not have admitted the patients in 29% of the cases.
  
  
  CONCLUSIONS
  ED medicolegal and professional concerns may substantially increase admissions for possible ACS. An acceptable miss rate or a zero medicolegal risk environment could potentially lead to a major reduction in admissions that physicians feel to be clinically unnecessary.
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Brooker
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hastings
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Hannah
authors.initials: H
authors.lastname: Major-Monfried
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Chad P
authors.initials: CP
authors.lastname: Maron
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Maia
authors.initials: M
authors.lastname: Winkel
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: H R Sagara
authors.initials: HR
authors.lastname: Wijeratne
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.|Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT.
authors.forename: William
authors.initials: W
authors.lastname: Fleischman
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.|The Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Scott
authors.initials: S
authors.lastname: Weingart
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: David H
authors.initials: DH
authors.lastname: Newman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D002637:Chest Pain; D003675:Defensive Medicine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male