CLINIC CARE AT the Massachusetts General Hospital was instituted in 1821 as an adjunct to the main activity of the hospital. It was offered as a form of charity to individuals who required medical care but not bed rest. Since that time, the character of hospital activities has changed as knowledge, facilities, and social attitudes have changed. In response to the needs of the community and a desire for better patient care, teaching, and research, ambulatory facilities find themselves faced with the challenge of increased utilization throughout the country. From 1954 through 1958, for example, outpatient visits countrywide increased 30% over 1948 to 62 million.1 There are now three outpatient department visits for every inpatient admission, and this ratio is rising.
This increased utilization of ambulatory services is recognition of the fact that present day outpatient facilities in larger hospitals are in a position to offer a wider range of