Preliminary data developed by the Health Care Financing Administration under its pilot cooperative cardiovascular screening project indicate that 50 percent of Medicare heart attack patients arriving in emergency departments who are appropriate for thrombolytic therapy do not receive it within the time period specified by the American College of Cardiology. Indicators developed for quality assurance monitoring and evaluation of a hospital emergency department prompted closer review of some cases. It was determined that a critical outcomes team using the principles of total quality management and the FOCUS-PDCA models should be empowered to deal with these issues. Through this process, the need for the development of a chest pain center at the hospital was identified and supported.