TY - JOUR T1 - Interface medicine: a new generalism for the NHS JF - British Journal of General Practice JO - Br J Gen Pract SP - 492 LP - 493 DO - 10.3399/bjgp17X693173 VL - 67 IS - 664 AU - Daniel Lasserson Y1 - 2017/11/01 UR - http://bjgp.org/content/67/664/492.abstract N2 - We are practising medicine at a time of unprecedented demand in the acute care pathway, with capacity reaching saturation in both primary care1 and in hospitals.2 While these facts alone mandate a change in how we deliver acute medical care, we are aware that, for some of our patients, the hospital bed-based model of care can cause unintended harms.3 The negative impact of acute institutional care, compared with a credible community-based alternative, can be seen in the differential rates of harm in trials of hospital in the home.4 Observational studies have also linked the hospital environment to ongoing functional decline, over and above the impact of acute illness.5 Faced with these data, how do we change the model of care for acute medical illness and create a sustainable acute care pathway?The Royal College of Physicians’ Future Hospital Commission recognised that the existing structures of acute care are no longer fit for all of our contemporary population.6 Ambulatory emergency care is recommended as a default care model but this leaves a formidable number of unknowns: the physical environment for assessment, patient selection for ambulatory rather than hospital care, the mix of professional skills needed to deliver safe out-of-hospital care, the diagnostic test platform and range, monitoring and interventions in the community, costs, and patient and carer experience of home-based care at higher levels of acuity of illness. Given these uncertainties, how do we construct services that deliver cost-effective ambulatory care?Although there is some guidance from existing literature of hospital-level interventions delivered in the home environment,4 the majority of trials recruited patients who had been assessed … ER -