Necessity demands that clinical decisions be more heavily influenced by cost considerations. The medical profession has only recently recognized that our society cannot support the uncontrolled and perhaps limitless growth in health care expenditures. Thus, we are just beginning to evaluate potentially more efficient methods that could help minimize costs without sacrificing quality. Logic dictates that medical problems that are both common and relatively expensive be analyzed first. Less than one half of the patients admitted to coronary care units (CCUs) are ultimately shown to have acute myocardial infarctions, and a relatively large group of the patients who are observed in these very costly facilities are ultimately shown to have no evidence of myocardial ischemia.1 Therefore, a low-risk group may be identifiable and could include as many as 20% to 30% of the patients currently being considered for admission to CCUs.
In this context, the report of Lee et