The acute medical take: an outpatient specialty

The traditional model of acute medical care involves the admission of patients to hospital to be assessed by a consultant and facilitate access to investigation and treatment. This model has, however, led to a number of problems. Firstly, there is high bed occupancy which restricts access and increases the risk of healthcare-acquired infection. Secondly, only limited training opportunities are offered for junior medical staff in this setting. Thirdly, patients often receive care from a 'generalist' rather than a 'specialist' although there is increasing evidence that the most appropriate specialist provides the best patient care. Many medical emergencies could be managed in the outpatient (ambulatory) setting if the appropriate facilities were available including staff, environment and access to investigations. Emergency outpatient clinics can provide gold standard emergency care by providing structure to the acute take, ensuring access to the most appropriate specialist and training opportunities for junior medical staff.