Chest pain is a common presenting complaint for evaluation of a child (<18 years of age) in a pediatric cardiology clinic. Despite the large number of patients evaluated for this complaint, a cardiac cause is rarely found. The American College of Cardiology sponsored an Expert Panel to develop and publish Quality Metrics for evaluation of children 5-18 years of age for providers to use in order to deliver quality care to these patients. Using a Modified Delphi Process to reach consensus, they found that only 3 of 10 candidate quality metrics would be useful. Despite published criteria for use of cardiac testing for children with a presenting complaint of chest pain without co-morbid conditions (congenital heart disease, recent chest trauma, rheumatologic diseases, etc;) and without exertional chest pain, over one third of patients still underwent transthoracic echocardiograms. This result is significantly higher than published studies using consensus algorithm-based recommendations.