Mark DG, Huang J, Ballard DW, et al. - A high variability in resource utilization among emergency department (ED) patients with possible coronary chest pain led researchers to conduct a controlled cohort study examining the implementation of a graded coronary risk stratification algorithm (RISTRA‐ACS [risk stratification for acute coronary syndrome]) amongst 21 EDs of an integrated healthcare system.

• Thirteen EDs had access to RISTRA‐ACS within the electronic health record (RISTRA sites) beginning in month 24 of a 48‐month study period (January 2016 to December 2019); the remaining 8 EDs were included as contemporaneous controls.

• A total of 154,914 patients with a chief complaint of chest pain and serum troponin measurement in the ED were included as participants.

• Relative to control sites, RISTRA sites had a reduction in 30‐day objective cardiac testing among patients with low (≤ 2%) estimated 60‐day MACE risk (−2.5%, 95% CI −3.7 to −1.2%) and there was an increase in testing among patients with non‐low (> 2%) estimated risk (+2.8%, 95% CI +0.6 to +4.9%), with no significant overall change.

• Findings overall suggest an association of the implementation of RISTRA‐ACS with better allocation of 30‐day objective cardiac testing and no change in index visit resource utilization or 60‐day MACE.