Ambulatory Care

Objectives

Describe ambulatory care Identify major impacts on ambulatory care

practice Identify and describe current ambulatory

practice settings Compare practice in ambulatory and

inpatient settings

Ambulatory Care Defined

A specialty practice area which is community based

May take place in different sites – hospitals, schools, workplaces or homes

Encounter may be face-to-face or by phone

Requires rapid response to high volumes of patients in a short span of time while dealing with issues that are not always predictable

American Academy of Amublatory Care Nursing, Ambulatory Care Nursing Administration and Practice Standards, 2007

Ambulatory Care is Changing

As the costs of acute care services increase, as new technologies are adopted & as reimbursement shrinks, patient care is being shifted to the outpatient setting resulting in increased patient volume and sicker patients.

Current Trends Impacting Ambulatory Care

Increasing life expectancy Environmental threats Increased legislation & regulation Technological Advances (clinical & non-

clinical) Consumer awareness

Ambulatory Patient Characteristics

Acutely ill requiring triage & possible emergency care Acutely ill requiring support, diagnosis & treatment Chronically ill requiring ongoing monitoring & assistance

with education/self-management Chronically ill with acute exacerbation In need of a defined treatment & procedure In need of education, reassurance & support In need of preventive services May not walk in &/or may not walk

out

Where Ambulatory Care is Practiced

University hospital outpatient

Community hospital outpatient

Solo & group medical practices

HMO Government health

systems

Occupational health centers

School health clinics Shelters for the

homeless Community clinics Surgical procedure

centers Urgent care centers

Ambulatory Care at Kaiser Permanente Southern California Kaiser Permanente is America's largest not-for-profit

health plan It includes

the nonprofit Kaiser Foundation Health Plan Kaiser Foundation Hospitals (13 medical centers) for-profit Permanente Medical Groups (ambulatory care)

148 Medical Offices Over 3 million members 47,000 FTEs,57,000 employees

As of January 2010 – KP.org

Inpatient Practice vs. Ambulatory Practice

Aspect of RoleAspect of Role InpatientInpatient AmbulatoryAmbulatory

Treatment episode

Inpatient Visit/phone/email

Observation mode

Direct & continuous

Episodic

Management of treatment plan

Nurse - Input from patient &/or family

Patient &/or family-Input from nurse

Primary Intervention Mode

Direct Consultative

Organizational presence of nursing

Nurse managed dept.

May or may not be formal nursing structure

Workload variability/intensity

Bed capacity, staffingratios

Scheduling system,

Ambulatory Care Nursing Administration and Practice Standards, 2007

First edition published First edition published 1987 1987

As specialty has expanded As specialty has expanded & the outpatient & the outpatient environment has gone environment has gone through dramatic changes, through dramatic changes, the standards were the standards were revised.revised.

Kaiser PermanenteNursing Vision and Model

“Extraordinary Nursing Care.

Every Patient. Every Time.”