Although the inpatient versus observation narrative usually grabs all the attention, a recent guideline from the American College of Cardiology (ACC) on chest pain adds emergency room versus observation into the mix.^[1] The guideline “recommends a dramatic change in disposition of some chest pain patients,” said William Rifkin, M.D., associate vice president and managing editor of MCG Health, in a white paper.^[2] As a practical matter, it should help send low-risk patients home from the emergency department (ED) in a few hours and prevent medically unnecessary observation stays.

“I’m not sure this is fully appreciated,” Rifkin told RMC.

The ACC changed its guidelines for chest-pain patients who are identified in the ED as low risk, which he said are patients who are very unlikely to have a heart attack or major adverse cardiac event in the next 30 days. “Usually, the friction point is observation versus inpatient,” he said. “For this population, it’s ED treatment and release versus observation because not much testing needs to be done.”