Background: Chest pain (CP) accounts for 6 million ED visits and 50% of these are admitted for CP management. Nearly 70 % are not proven to have ACS. Challenge of CP diagnosis is thus associated with high economic burden. Aim: To evaluate the variation in CP management among teaching & non-teaching teams (NTT) Methods: Design: Prospective Observational study Setting: Single center investigation at acute care hospital Patients: 820 patients admitted with chief complaint CP to both teams from July -Nov 2011. 517 patients included in final analysis. Patients with more than one chief complaint& insufficient data were excluded. Patients identified through ED admit nurse registry on daily basis Assessment tools (AT): 5 AT described as length of hospital stay (LOS), readmission within 1 month(ROA), cardiology consult (ROC), intervention rates-non-invasive & invasive (ROI) & Co-morbid disease score based on number of co-morbid conditions (COMB) were used. Results: 70 % had non-typical CP at presentation. 13 % with non-typical CP had ACS v/s 66 % with typical CP (p-<0.001). Mean LOS was same at 2.67±1.9 days in both teams. COMB score was 4.12± 1.5 v/s 3.91 ±1.5, p-0.16, showing that both teams had similar co-morbid conditions. ROA was also not different (11.3 %± 1.5 v/s 12.7 % ±1.3, p-0.23). ROI was 46 % and near significantly high in NTT (50.5%, p-0.07). ROC was higher in NTT (67% v/s 52%, P-0.002), but associated with ACS diagnosis (p-0.005, OR 2.78). ROI & ROC did not result in significant increase in the total LOS. Overall, higher ROC was observed with ACS (p-0.001, OR-8.017), males (p-0.007, OR-1.73) & cardiac history (p-0.001 OR-2.2). Increase ROI was seen with typical CP (p-0.028, OR 1.66), ROC (p-0.001, OR 8.6) and resulted decrease in ROA (p-0.02, OR 0.50). On sub analysis of ROI, only teaching teams remains associated with reduction in readmission (p-0.03, OR-0.27). COMB Score ≥5 was associated with ROA (O.R. =7.82, 95 % CI, p=<0.001). Conclusion: There was no statistical differences found in the length of stay and readmission’s between teams. Non teaching teams used more consult services & interventions but showed no difference in any quality markers. Interventions resulted in concomitant decrease in readmission among teaching teams only. If validated COMB score can be used as a readmission predictor tool. Future efforts should be made to recognize the judicious use of cardiology consult services in timely fashion for effective management of CP patients.