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 & nonclinical) 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 Role
Treatment episode Observation mode

Inpatient
Inpatient Direct & continuous

Ambulatory
Visit/phone/email Episodic

Management of treatment plan

Primary Intervention Mode

Nurse - Input from patient &/or family

Direct

Patient &/or familyInput from nurse

Consultative May or may not be formal nursing structure Scheduling system,

Nurse managed dept. Organizational presence of nursing Bed capacity, staffing Workload variability/intensity ratios

Ambulatory Care Nursing Administration and Practice Standards, 2007

First edition published 1987 As specialty has expanded & the outpatient environment has gone through dramatic changes, the standards were revised.

Kaiser Permanente Nursing Vision and Model

Extraordinary Nursing Care. Every Patient. Every Time.