Within health services there is concern that escalating costs may reflect an inappropriate use of services and that services should avoid admitting patients who do not require acute care. The problem is, if these patients exist, how may they be identified and is this the sole consideration in patient management? This triangulated study examines the appropriateness of admissions, factors that influence that admission, and the potential to develop alternate models of care for medical patients. A utilization review, auditing 521 medical patients, provided a percentage of appropriateness of admission and stay, identified the barriers to discharge and those patients suitable for programs such as hospital in the home. Complementing the review, interviews with eight physicians explored how they decided to admit patients, what factors influenced that decision and their attitude to the development of these models of care.