In March 2007, the National Health Service (NHS) Institute for Innovation and Improvement published a Directory of Ambulatory Emergency Care for Adults.1 The directory lists conditions that can be clinically managed outside hospital, with appropriate and prompt access to diagnostic services and specialist advice.

Admissions to hospital are an increasing source of pressure on health system resources internationally. In the NHS, changes to commissioning arrangements have increased the drive to reduce hospital admissions.2 Unplanned admissions make up 36.7% of hospital admissions in the United Kingdom (4 659 054 emergency admissions in 2005-6).3 The Department of Health has introduced a national target to reduce the number of emergency bed days by 5% by 2008.4

Most of the evidence on the cost effectiveness of reducing admissions comes from the United States. Ways to reduce admissions include case management, observation units for the evaluation of acute conditions, and the provision of home health care.5 6 Research from other countries, …