ST3 Acute Medicine Interview
Can you give examples of ambulatory care pathways that reduce unnecessary hospital admission episodes?
Assessment without recourse to a hospital bed
• Assessment of low-risk chest pain patients, for those awaiting a troponin check pending discharge home
• Ambulatory patients with suspected deep vein thrombosis that can undergo Doppler ultrasound scanning in an outpatient clinic setting.
• Access to specialist diagnostic and outpatient services can negate the need for hospital admission, e.g. assessment of patients with suspected transient ischaemic attack
Treatment in an outpatient rather than inpatient setting
• There has been a progressive move towards outpatient management of thromboembolic disease in appropriate patients, provided that treatment can be monitored closely in a dedicated anticoagulation clinic or motivated GP surgery
• Cellulitis can be managed in on an outpatient basis, helped by the availability of intravenous antibiotics that require administration only once daily; there is evidence to show that this can be safely undertaken with daily attendance at hospital, or in the home environment with self-administration