Problem & Purpose: More than 40% of patients admitted with diagnosis of non-ST elevation myocardial infarction (NSTEMI) in the emergency department, remain as NSTEMI by discharge despite majority being ruled out by cardiology and do not receive NSTEMI management in accordance with the American Heart Association-Get with the Guideline (AHA-GWTG) protocol. This lack of diagnosis reconciliation by discharge portrays the cardiology program as noncompliant with the AHA-GWTG reporting system that recommend 85% management rate. The purpose of this process quality improvement project is that by discharge, the type 1 NSTEMI patients are confirmed, and matched to therapeutic management, excluding the non-NSTEMI patients. Methods: A best practice advisory (BPA) was built into the electronic medical records (EMR), that prompted providers at discharge to accept if patient was a true NSTEMI. The BPA is built into the admission, discharge, and transfer (ADT) section of the EMR and is triggered by the AHA-GTWG entry criteria: “Chest pain”, “angina”, and “NSTEMI” with corresponding ICDcodes in the hospital’s diagnostics database. Any of these three presenting index problems is matched with an elevated troponin 5th >/= 10 ng/dL to trigger the BPA. Results: In the 14 weeks of data collection, result shows the BPA met target for patient population and units, it triggered 100 times on 100 patients. Duplicates triggers were eliminated. Providers responded to the BPA 11.1% of the time and confirmed 10 NSTEMI patients out of actual 34 according to audit. Compliance rate of 100% was achieved in weeks 6 & 7 with more responses to the BPA. Response rate dropped down to 0 as providers needed frequent reminders to engage. Conclusions: Selective use of BPAs are effective tools to manage patients using set guidelines. This BPA was not a hard stop; hence it was easy to bypass. Internal goal of 100% compliance rate is achievable if providers are made to respond 100% of the time.