Evaluation of patients with possible cardiac chest pain: a way out of the jungle.

Emergency department (ED) overcrowding is a national health problem. From 1997 to 2007, the annual number of ED visits in the United States increased from 95 to 117 million, whereas the number of EDs decreased by 10% (1). This increased volume has put demands for acute care services at more than can be provided: 50% of urban hospitals and 31% of rural hospitals continuously operate at or over capacity (2). ED overcrowding is associated with adverse cardiovascular outcomes (3), reduced use of guideline-recommended therapies, and a higher risk of recurrent myocardial infarction (4).