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Bed shortages, efficient modern diagnostic services and increasing risks associated with hospital admission, require review of conventional medical practice. Patients referred as emergencies who are walking, talking sense, eating and drinking and have normal sphincter function can usually be managed as outpatients. Widespread adoption of this practice would require more general physicians and nurse practitioners near the front door, rapid access and early review clinics and prompt diagnostic support. Education of the public, changes in medical training and reallocation of resources would reduce the need for inpatient management, providing beds for those in real need.

The concept, delivery and future of medical ambulatory care