Observation area for patients with acute myocardial ischemia.

Detection program to target and educate patients with coronary artery disease (based on a positive stress test) and patients with increased risk factors (based on history and blood tests).

Education outreach program in conjunction with the hospital's rehabilitation department, to communicate to the public that warning signs precede heart attacks.

Medical educational programs involving CQI, HCFA MI indicators, NHAAP recommendations, etc. The goal is the relentless pursuit of teamwork for maximal benefit to the patient, the hospital, and society.

Proper staffing ratio of critical care nurses, as well as critical care physicians with a continuous retraining program for heart attack management.

Appropriate technology that is timely and available 24 hours, with prompt backup interpretation. These include enzymes (CPK/MB, myoglobin, and Troponin), ST monitoring, technetium sestamibi, nuclear testing, echo, and stress testing.

If you are interested in the evolution and changing dynamics of Chest Pain Centers with emphasis on cost effectiveness and critical pathways contact: Raymond D. Bahr, M.D., FA.C.P St. Agnes HealthCare 900 Caton Avenue || Baltimore, MD 21229 410-368-3200 E-mail: info@ehac.org Web Site: http://www.ehac.org http://www.chestpain.org http://www.chestpaincenters.org http://www.cped.org

1. Guidelines for Chest Pain Centers. American Journal of Cardiology - November15, 1995, Vol 76.

2. Growth in Chest Pain Emergency Departments Throughout the United States: A Cardiologist's Spin on Solving the Heart Attack Problem - Coronary Artery Disease 1995, 6:827.830.

3. Acute Outpatient Care and Comprehensive Management of Acute Myocardial Ischemia in Chest Pain Emergency Departments - Maryland Medicine Journal, September 1995.

4. Clinician® - 2nd National Congress of Chest Pain Centers - Vol 14. #4 August, 1996.