This article is a prospective evaluation of 38 patients presenting to an emergency department (ED) with hematemesis but who were otherwise hemodynamically stable. Four patients were admitted, only one because of the development of hemodynamic instability. Thirty-three patients were discharged; on follow-up there was no evidence of major morbidity or mortality. Two patients were lost to follow-up, one who left against medical advice and one who lived in a county outside the service area of our hospital. Patients with hematemesis can be safely discharged from the ED after observation for 6 hours if they: (1) lack orthostatic vital sign changes; (2) lack associated significant underlying disease; (3) have a hemoglobin concentration greater than 10 gm/dL; (4) are less than 60 years of age; and (5) are thought to be reliable and compliant.