Surgical outpatients: challenges and responses.
BACKGROUND
Faced with upward pressure on costs from ageing populations and new technologies, those responsible for funding health care are seeking innovative ways of providing that care at lower cost. A common strategy is to shift care from the inpatient to the outpatient setting. This, taken with pressure for greater accountability and improved training, is creating great challenges for those responsible for organizing outpatient care. This paper seeks to review these challenges and the various responses to them.


METHODS
A critical review of literature on the changing role of outpatient care, with an emphasis on the current situation in the United Kingdom.


RESULTS
Many diverse responses have been developed to address the changing nature of outpatient care. These have certain features, including the recognition that clinicians have the ability to initiate, rather than simply react to change, and an appreciation of the value of clear and definable objectives for outpatient care. They range from discrete interventions addressing a single concern to wholesale restructuring of the system of care, such as one-stop clinics.


CONCLUSIONS
There is now considerable evidence on what can and should be done to improve the existing system of outpatient care.
Waghorn
A
A
London School of Hygiene and Tropical Medicine, London, UK.
McKee
M
M
Thompson
J
J
D000556:Ambulatory Surgical Procedures / Q000592:standards; D002985:Clinical Protocols; D004501:Education, Medical; D006297:Health Services Accessibility; D006801:Humans; D008485:Medical Audit; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D010353:Patient Education as Topic; D011787:Quality of Health Care; D012017:Referral and Consultation; D012106:Research