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Background: The Vancouver Chest Pain Rule is designed to safely reduce hospital admissions of emergency department patients with chest pain. We describe the impact of provincial implementation of the Vancouver Chest Pain Rule on hospital admissions. Methods: From 2017 to 2018, in 29 British Columbia emergency departments that had a wide range of patients and resources, we encouraged the use of the Vancouver Chest Pain Rule via a coordinated campaign that included in-person meetings, webinars, and online messaging. In a retrospective cohort, we collected all chest pain patients from 2016 to 2017 (before) and 2018 to 2019 (after) for the primary outcome of 30-day hospital admission. Results: We collected 94 058 (before) and 90 170 (after) visits. Median ages (56), gender (female: 50%), and comorbidities were similar. The admission rate decreased from 23.7% to 22.5% (relative decrease 5.3%; absolute decrease 1.3%). Conclusions: An organized implementation of the Vancouver Chest Pain Rule was associated with a 5.3% relative reduction in hospitalizations, which translates to 1300 fewer hospitalizations annually. [ABSTRACT FROM AUTHOR]