Chest Pain Level of Care

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Current guidelines indicate that most patients who need immediate evaluation of chest pain can be managed initially in observation if all the following criteria are met:
• Chest pain relieved prior to admission orders
• Vital signs stable
• Electrocardiogram (EKG) showing no significant findings or
unchanged from prior EKG
• Unremarkable chest X-ray for acute disease
• Normal cardiac markers, especially troponin level in nonischemic range

Documentation of only “atypical” or “nonspecific” chest pain; “angina” or “rule out MI” does not support inpatient admission.

The following confirmed or suspected findings may justify inpatient care, assuming clinicians provide management consistent with inpatient medical necessity for hospital level of care.
• “ACS” with left bundle branch block (new or undetermined age)
• Significant EKG changes (new): ST depressions > 0.5 mm, T-wave inversions > 1 mm, LBBB, paced rhythm

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