Cost effective nuclear scanning in a comprehensive and systematic approach to the evaluation of chest pain in the emergency department.

The cost of evaluation and treatment of patients presenting to the emergency department with chest pain is estimated in billions of dollars. Current standards of practice, however, cannot reliably distinguish between high- and low-risk patients. Efficient management of this population requires that we reduce: 1) delays in therapy, 2) soft admissions, 3) inappropriate dispositions, and 4) cost. In a multidisciplinary effort, the acute cardiac team developed a comprehensive evaluation and triage strategy based on risk. Our data suggest that we have been able to accomplish all four goals, including a reduction in overall costs through the use of perfusion imaging.