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Background: ACRE pathway was implemented at TUH in October 2018. The aim of this study was to analyse its impact on exercise stress test (EST) referrals in TUH. Methods: Retrospective analysis of 558 emergency department (ED) chest pain presentations was done over six months, including the appropriateness of risk stratification and referrals for EST, waiting time for EST, and representations to ED whilst awaiting EST. Results: Of the 558 ED presentations, 76.7% had risk category documented appropriately. Only 48.4% of the intermediate risk patients were referred for an outpatient EST from ED. Of the 132 EST referrals, the median waiting period was 4 weeks, with 51 (39%) completed within 2 weeks. There were 91 representations to ED while waiting for EST, and 48 (54%) of those patients were discharged from ED. Conclusion: As expected, implementing change to accelerated diagnostic protocol significantly increased the EST referrals.