Introduction: Greater than (5%) of all Emergency Department (ED) patients present with chest pain related symptoms nationally. EDs in the United States will see approximately five million patients annually presenting with a complaint of chest pain (Pollack & Perman, 2017). These numbers can be exacerbated during times of stress, specifically during a national pandemic with presenting symptoms mimicking anxiety, respiratory or psychiatric issues. These visits can quickly erode the existing resources of a rural hospital ED. While many rural EDs are equipped to handle chest pain emergencies, during public health crisis (i.e. COVID-19), the ability to implement evidence-based interventions in a timely manner can be a critical challenge due to infection control measures and limited staffing. Project Goals/ Objectives: The purpose of this project was to compare if benchmarks of patients presenting with chest pain have treatment delays during COVID-19 pandemic as compared topre-COVID-19 in the ED of a small rural hospital. The measures were reviewed with an emphasis on the effects caused by the COVID-19 pandemic to develop an innovative, interdisciplinary initiative to reduce time delays in patients receiving ED services. Results: Increased delays in Door to ECG, Total Length of Stay, Door to Transfer and Door to Lab times were noted in the post COVID-19 period . While Visits to the ED decreased pre_x0002_COVID-19, it significantly increased after COVID-19 began. However, Door to Provider times significantly improved after the pandemic response in March 2020. Running head: EXAMINING IMPACT OF COVID-19 ON RURAL ED 4 With respect to variability, increased variability was noted in the post COVID-19 period for the measures of Door to ECG, Door to Transfer, and for Total Length of Stay. Further examination of latency in data trends suggested that these changes took place five to seven months after the March 2020 response to COVID-19. Discussion: This project emphasized a need to look at the overall processes in the flow of the chest pain patient in this rural ED. While delays were minimized during the COVID-19 pandemic overall, timing metrics failed to meet both the internal and external benchmarks used within the facility before the COVID-19 pandemic and during the COVID-19 pandemic. Areas needing improvement will be prioritized to include processes which present both high risk and high occurrence rates. Improvement priorities will include processes which can be corrected with additional training and rearrangement of current flows which impede the timeliness of care.