An ECG was recorded in the vast majority of patients in this cohort (99.2%). However, a single normal 12 lead resting ECG does not exclude a diagnosis of ACS, and NICE guidance recommends that all patients should have serial ECGs and continuous monitoring with telemetry when clinically appropriate. This study has found that only 59.3% of patients admitted with chest pain received more than one ECG, and only 57.6% were continuously monitored with telemetry. Serial ECGs improve the outcomes of patients later diagnosed with both ACS and MI, and their use is recommended in high risk patients .