The Chest-Pain Unit — Ready for Prime Time?

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Abstract
For much of this decade, managed care has led a private, market-driven “reform” of the U.S. health care system. The introduction of late-20th-century business practices into the cottage industry of medicine has not always been pleasant or productive. It has, however, created strong incentives to improve the efficiency of the delivery of care. The chest-pain unit (CPU) is largely a product of those incentives.As recently as 10 years ago, cardiologists were routinely taught that a diagnosis of myocardial infarction could not be ruled out in the emergency department. If the possibility of myocardial infarction was great enough, the patient . . .