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The Dichotomy of Inpatient and Outpatient Internal Medicine The hospital environment has transformed dramatically over the past few decades. In more recent times, emergency departments and critical care units have evolved to identify and manage critically ill patients, allowing them to survive formerly fatal diseases. There is increasing pressure to reduce the length of stay in the hospital and to manage complex disorders in the outpatient setting. This transition has been driven not only by efforts to reduce costs but also by the availability of new outpatient technologies, such as imaging and percutaneous infusion catheters for long-term antibiotics or. | Chapter 001. The Practice of Medicine Part 6 The Dichotomy of Inpatient and Outpatient Internal Medicine The hospital environment has transformed dramatically over the past few decades. In more recent times emergency departments and critical care units have evolved to identify and manage critically ill patients allowing them to survive formerly fatal diseases. There is increasing pressure to reduce the length of stay in the hospital and to manage complex disorders in the outpatient setting. This transition has been driven not only by efforts to reduce costs but also by the availability of new outpatient technologies such as imaging and percutaneous infusion catheters for long-term antibiotics or nutrition and by evidence that outcomes are often improved by minimizing inpatient hospitalization. Hospitals now consist of multiple distinct levels of care such as the emergency department procedure rooms overnight observation units critical care units and palliative care units in addition to traditional medical beds. A consequence of this differentiation has been the emergence of new specialties such as emergency medicine intensivists hospitalists and end-of-life care. Moreover these systems frequently involve hand-offs from the outpatient to the inpatient environment from the critical care unit to a general medicine floor and from the hospital to the outpatient environment. Clearly one of the important challenges in internal medicine is to maintain continuity of care and information flow during these transitions which threaten the traditional one-to-one relationship between patient and physician. In the current environment teams of physicians specialists and other health care professionals have often replaced the personal interaction between doctor and patient. The patient can benefit greatly from effective collaboration among a number of health care professionals however it is the duty of the patient s principal or primary physician to provide cohesive guidance through
