A hospital stay, complete with Jell-O and the rhythmic beeping of monitors at 3 AM, is a fixture of post-surgery care. But healthcare is increasingly shifting from inpatient wards to outpatient settings. A 2024 forecast from the healthcare analytics and consulting company Sg2 predicted a 17% increase in outpatient volume to 5.82 billion in the next 10 years in the U.S., compared to only a 3% rise in inpatient volume (to 170 million).
Outpatient care doesn’t just encompass routine check-ups or minor sprains. Complex orthopedic surgeries, cardiac interventions and advanced diagnostic procedures are common in outpatient settings. This shift is driven by factors like the emergence of minimally invasive technologies and economic pressure.
This shift begs a question: Is it possible to maintain hospital-level safety without the hospital? Dive into the data and insights from the Sermo community to see where the opportunities—and the shortcomings—exist according to a global physician network.
Outpatient vs inpatient care: what are the benefits?
The Sermo community responded to a poll asking what they saw as the biggest advantage of shifting more care to outpatient settings. The results highlighted a mix of economic pragmatism and patient-centric care.
Reduced costs for patients and systems
The economic argument drew the most votes, with 46% of surveyed physicians citing reduced costs as the biggest advantage. Hospitals are high-overhead environments. The shift of care to streamlined outpatient centers bypasses the costs of overnight staffing. “Cost savings are incredibly important to our publicly funded model,” allowing the system to “work smarter, not harder,” notes a family medicine doctor in Canada. In the U.S., the conversation around site-neutral policies is gaining traction, suggesting that Medicare reimbursements should be the same regardless of the setting, which further incentivizes low-cost outpatient solutions.
Greater patient convenience
For patients, the ability to recover in their own bed and eat their own food is a massive psychological benefit. This took second place in the poll, with 23% of physicians identifying greater patient convenience as the primary advantage. A general practitioner and Sermo member pointed out the difference in environments: “In outpatient care, the patient is immersed in their real life; in inpatient care, the environment is controlled, which often makes changing the patient’s habits very difficult.”
Faster throughput and scheduling flexibility
Hospitals are often bottlenecked by bed availability, and an outpatient clinic doesn’t have this problem to the same degree. 13% of poll respondents pointed to faster throughput as a key benefit.
Lower infection risk compared to inpatient care
Nosocomial infections are a reality of hospitals and outpatient clinics alike. The U.S. Centers for Disease Control (CDC) notes a lack of data surrounding the prevalence of infections in outpatient settings, despite “numerous reports of outbreaks.” Still, 9% of Sermo respondents felt that a lower infection risk in outpatient settings was the standout benefit, with a geriatrics specialist noting that “there is less exposure to nosocomial organisms” in these settings.
Improved patient satisfaction
While only 6% of voters selected this as the top advantage, it has implications for care quality. Patients may prefer to avoid the hospital setting as much as possible, and happy patients are generally compliant patients. “Outpatient care significantly improves patients’ quality of life,” writes a general practitioner on Sermo.
The main risks of outpatient treatment
While outpatient care promises efficiency, it’s not without downsides. Here is what concerns physicians the most about ambulatory care, based on Sermo poll results.
Pressure to reduce costs at the expense of safety
Physicians fear that efficiency can sometimes bleed into corner-cutting. 24% of poll participants—the highest vote in this poll—fear that the pressure to turn over rooms and keep costs down compromises safety. This might look like rushing a discharge before a patient is fully stable, or skimping on supplies. “Safety is paramount and we should not push too far,” warns a neurologist.
Emergency management limitations
The reduced capacity for urgent interventions in outpatient settings was a close second, cited by 21% of physicians in the Sermo poll. In a hospital, a “Code Blue” swiftly brings a swarm of experts, including specialists and rapid-response resources. In contrast, a standalone clinic may have only a physician and a nurse on hand while awaiting an ambulance. If a patient experiences severe complications such as bleeding out or developing a pulmonary embolism, the life-saving resources to rescue them are far more limited. A general practitioner on Sermo calls “limited emergency support” — a primary challenge around the shift to outpatient care.
Inconsistent staffing or training levels
18% of respondents worry about staffing. Staff might be cross-trained to handle front desk duties and recovery, leading to a dilution of clinical focus. “Adequate staffing, training and resources are the biggest concerns,” a general practitioner writes on Sermo.
Variability in regulatory oversight
Hospitals and outpatient clinics are both scrutinized by accrediting bodies (for example, hospitals and outpatient clinics are subject to separate standards in the U.S.). Still, 6% of respondents are concerned that outpatient settings don’t need to meet as strict of standards. In some jurisdictions, an office-based surgical suite doesn’t face the same rigorous inspection schedule as a hospital OR.
Limited access to diagnostics or imaging
13% of doctors worry about the lack of immediate diagnostics in an outpatient center compared to a hospital. An inability to rapidly rule out serious complications forces physicians to transfer patients to the ER for workups that could have been simple inpatient checks, effectively negating the efficiency gains.
Discharge follow-up challenge
Once the patient leaves the parking lot, they are largely on their own. 8% of respondents cited discharge follow-up as the biggest hurdle. In a hospital, a nurse checks vitals every few hours. At home, it’s up to the patient or their family to recognize signs of deterioration.
How to mitigate the risks of outpatient treatment
Physicians on Sermo have identified the following as the best solutions to the potential drawbacks of increased outpatient care.
Standardized safety protocols
Some Sermo members are in favor of standardized safety measures. “It is desirable that outpatient clinics have well-defined protocols,” writes one emergency medicine physician. Strict admission criteria can help ensure only appropriate candidates are selected for outpatient procedures, minimizing the risk of surgeries in settings not equipped for them.
Staffing and workforce development
Participants in a Sermo poll most commonly (41%) said that staff expertise is the factor that most influences safety in an outpatient setting. Regular simulation training for emergencies (such as malignant hyperthermia drills or cardiac arrest) within the outpatient setting can help ensure that even if emergencies are rare, the staff’s response is practiced and professional.
Equipment and resource investment
11% of respondents emphasized the availability of appropriate equipment. Investment in proper monitoring equipment, crash carts that mirror hospital standards and reliable supply chains for emergency drugs ensures safety.
Patient education and discharge planning
Suitable discharge planning can help mitigate follow-up risks. As one general practitioner on Sermo describes, it involves confirming discharge only when strict checks are met, providing a direct phone line for problems, and mandating a nurse follow-up call the next day.
Data reporting and outcome tracking
Ambulatory care quality reporting can track unplanned hospital transfers, infection rates and “failure to rescue” events. Data reporting helps identify underperforming centers and spread best practices from the high performers.
Integration with inpatient systems
Integration with inpatient systems ensures that if a transfer is needed, it is seamless. 23% of poll respondents consider access to transfer pathways to be the main factor dictating safety. Electronic health records (EHR) should talk to each other, so that for example, the ER doctor knows exactly what happened at the surgery center an hour ago.
The preparedness gap for unexpected complications
A concept in medicine called “failure to rescue” refers to the inability to prevent a complication from becoming a mortality. Polled physicians on Sermo see this as a major risk in outpatient settings. Only 8% felt outpatient centers were “very prepared” with strong protocols. Meanwhile, a combined 70% felt they were either “adequately prepared with gaps” or “minimally prepared.” A general practitioner emphasizes the importance of preparedness: “It’s essential to have protocols in place for emergencies (for example, referring patients to the emergency room when there are any warning signs).”
The challenge lies in managing “low-probability, high-impact” events. For instance, a severe hemorrhage event requires immediate access to blood products on site or a massive transfusion protocol that activates instantly. Similarly, rapid transport protocols are critical—delays such as waiting 20 minutes on hold with dispatch can be life-threatening. These scenarios underscore the need for outpatient centers to proactively identify gaps, implement clear emergency procedures, and ensure that staff are trained to respond efficiently, bridging the gap between outpatient care and hospital-level support.
What this means for doctors and the future of outpatient care
Ultimately, technology and economics will continue to push care outward. But physician-led governance can help protect clinical standards from being washed away by the tide of efficiency.
When we asked if this shift toward outpatient care would improve outcomes long-term, 33% of polled Sermo members said yes, but only with proper safeguards. Another 37% said yes, but only for select populations.
One way physicians are influencing this transition is through working in ambulatory surgery centers (ASCs). As more procedures migrate out of hospitals, ASCs are emerging not only as care sites, but as opportunities for physicians to take a more active role in setting protocols, overseeing quality and shaping patient selection criteria. For some doctors, involvement in ASCs—whether through clinical leadership, ownership or moonlighting—offers a way to directly improve outpatient safety while diversifying their careers.
Healthcare’s current trajectory suggests the future of medicine is increasingly ambulatory. It promises a world of convenience and lower costs, but physicians caution that convenience should never supersede safety. In both hospital and ASC settings, clear guidelines around credentialing, escalation pathways, and complication management can help prevent operational efficiency from overriding clinical judgment.
Where do you stand on outpatient safety? Join the Sermo community to share your criteria for credentialing and complication management, and hear from other members who are passionate about the topic.
