Objectives: For patients in whom acute coronary syndrome (ACS) is a concern, disposition decisions are complex and multifactorial and have traditionally been a source of considerable variation. An important factor in disposition decisions for these patients may be physician-perceived medicolegal risk and related professional concerns. The study aim was to determine, at the point of care, how much less frequently physicians report that they would admit possible ACS patients if there was either zero or a defined medicolegal risk.Methods: This was a point-of-care emergency physician survey. Research assistants approached physicians at or immediately following the moment of disposition decisions for patients who were being admitted for ACS. The primary outcome measures were the proportion of physicians reporting that patients would not have been admitted if medicolegal issues were of no concern and the proportion of physicians reporting that patients would not have been admitted if there was an "acceptable miss rate" of 1% to 2% for ACS patients.Results: During the 3-month study period, 576 patients were admitted to an inpatient unit or to the ED observation protocol. Physicians were approached in 271 cases, and 259 surveys were completed. When presented with hypothetical zero medicolegal risk, physicians answered that they would not have admitted the patients in 30% of cases. With a hypothetical 1% to 2% acceptable miss rate, physicians indicated that they would not have admitted the patients in 29% of the cases.Conclusions: ED medicolegal and professional concerns may substantially increase admissions for possible ACS. An acceptable miss rate or a zero medicolegal risk environment could potentially lead to a major reduction in admissions that physicians feel to be clinically unnecessary.ACADEMIC EMERGENCY MEDICINE 2015;22:883-886 © 2015 by the Society for Academic Emergency Medicine A cute coronary syndrome (ACS) is a common concern in emergency department (ED) settings and a common reason for extended evaluation using accelerated diagnostic protocols in observation units or inpatient hospital settings. For patients in whom ACS is a concern, disposition decisions are complex and multifactorial and have traditionally been a source of considerable variation.1,2 An important factor in disposition decisions for these patients may be physician-perceived medicolegal risk and related professional concerns. [3][4][5] Previous work has been done examining the concept of a test threshold, or "acceptable miss rate," for ACS. [6][7][8] However, such thresholds have not been routinely integrated into disposition decision-making and their possible effect on physician decision-making has, to our knowledge, not been previously reported.We aimed to determine, at the point of care, how often perceived medicolegal concerns affect physician