The editorial by Kaul and Abbott [1] suggests two practical approaches to assessing patients with chest pain of unknown origin in the emergency department: 1) Immediately involve a cardiologist in the assessment and decision-making process; and 2) observe and assess patients in a special chest pain unit located in or near the emergency department that is staffed by subspecialty nursing support.

In 1971, the Inter-Society Commission for Heart Disease Resources [2] recommended a system to shorten the delay in providing medical care for patients with suspected myocardial infarction. Features of this system included public and professional education programs, mechanisms to bring patients to early medical care, and three levels of special life-support stations to receive these patients.

In 1972, a fixed life-support station was established in the emergency department of a teaching community hospital in Rochester, New York, as part of a grant from the National Heart and Lung Institute [3]. The nursing pool of the cardiology unit and coronary care unit in this institution staffed this area. Between January 1972 and September 1973, 1064 patients were seen and 610 (57%) were admitted to the hospital's coronary care unit. Prospective studies were done on the 154 patients from this group who had confirmed acute myocardial infarction. Overall hospital mortality for these patients was 15.6%. Of 112 patients younger than 70 years of age, 51 arrived within 2 hours of symptom onset; only 3 of these patients (6%) died.

The investigators found this life-support station to be efficient in the immediate triage, care, and disposition of all patients who came to the education department during this time reporting chest pain. Several other clinical outcomes were realized, such as prompt recognition and treatment of serious arrhythmias, congestive heat failure, and cardiogenic shock.

Several potential conflicts were also noted, including 1) additional cost; 2) turf issues between the emergency department physician and nursing staff and the cardiology or cardiac care unit nursing pool; 3) possible infringement of the physician-patient relationship between the housestaff and the patient's attending physician; 4) the use of valuable emergency department space for a select patient group; 5) the potential loss of income to the institution from fewer hospital admissions; and 6) the potential political conflict with all provider parties that use the emergency department for care of patients in the cardiology division. In our experience, all these factors were manageable.

The life-support station was developed before more contemporary approaches to the care of patients with myocardial infarction were available. Such a station in today's emergency department should yield great benefits for the patient. In the late 1960s and early 1970s, many more experiences of the type reported above occurred. A systematic critique and review of these factors may identify effective strategies that could be easily implemented without much further study or increased cost.