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Laboratory test use varies across emergency departments (EDs), yet little is known about the effect of this variation on outcomes. The aim of this study is 2-fold to stratify EDs into clusters based on similar test use, and to determine whether the clusters differ in patient operational outcomes among patients presenting to EDs with undifferentiated chest pain. We conducted a retrospective cohort study of 222,788 patients presenting with undifferentiated chest pain at 44 EDs across New South Wales, Australia, from January 2017 to Septe