Reorganizing ambulatory care: an administrator's view.

Citing a continuing increase in the utilization of hospital outpatient services, the authors discuss the reorganization of the ambulatory care delivery system at a 300-bed community hospital serving the Cambridge, Massachusetts area. Due to the attrition of community-based physicians, the Mount Auburn Hospital had an overburdened emergency services and an underutilized outpatient department. To improve this situation, full-time physicians and a non-physician administrator were hired for the outpatient area. In the four years following the reorganization, patient volume has increased and utilization has shifted from emergency to primary care which has required the hospital to adjust staffing in several ancillary departments. The hospital has now reached the point where growth must be carefully planned and controlled in order to preserve cost-effective, high quality care. The authors conclude that planning for hospital-based ambulatory care units should include: (1) defining the needs of the target communities; (2) marketing programs; and (3) anticipating legislation which will influence the demand for outpatient services.