Ambulatory Care

ObjectivesDescribe ambulatory careIdentify major impacts on ambulatory care practiceIdentify and describe current ambulatory practice settingsCompare practice in ambulatory and inpatient settings

Ambulatory Care DefinedA specialty practice area which is community basedMay take place in different sites hospitals, schools, workplaces or homesEncounter may be face-to-face or by phoneRequires rapid response to high volumes of patients in a short span of time while dealing with issues that are not always predictableAmerican Academy of Amublatory Care Nursing, Ambulatory Care Nursing Administration and Practice Standards, 2007

Ambulatory Care is ChangingAs 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 CareIncreasing life expectancyEnvironmental threatsIncreased legislation & regulationTechnological Advances (clinical & non-clinical)Consumer awareness

Ambulatory Patient CharacteristicsAcutely ill requiring triage & possible emergency careAcutely ill requiring support, diagnosis & treatmentChronically ill requiring ongoing monitoring & assistance with education/self-management Chronically ill with acute exacerbationIn need of a defined treatment & procedureIn need of education, reassurance & supportIn need of preventive services May not walk in &/or may not walk out

Where Ambulatory Care is PracticedUniversity hospital outpatient Community hospital outpatientSolo & group medical practicesHMOGovernment health systems

Occupational health centersSchool health clinicsShelters for the homelessCommunity clinicsSurgical procedure centers Urgent care centers

Ambulatory Care at Kaiser Permanente Southern CaliforniaKaiser Permanente is America's largest not-for-profit health plan It includes the nonprofit Kaiser Foundation Health PlanKaiser Foundation Hospitals (13 medical centers)for-profit Permanente Medical Groups (ambulatory care)148 Medical OfficesOver 3 million members47,000 FTEs,57,000 employeesAs of January 2010 KP.org

Inpatient Practice vs. Ambulatory Practice

Aspect of RoleInpatientAmbulatory

Treatment episodeInpatientVisit/phone/emailObservation modeDirect & continuousEpisodicManagement of treatment planNurse - Input from patient &/or family Patient &/or family-Input from nursePrimary Intervention ModeDirectConsultativeOrganizational presence of nursingNurse managed dept.May or may not be formal nursing structureWorkload variability/intensity Bed capacity, staffingratiosScheduling system,

Ambulatory Care Nursing Administration and Practice Standards, 2007First edition published 1987 As specialty has expanded & the outpatient environment has gone through dramatic changes, the standards were revised.

Kaiser PermanenteNursing Vision and Model

Extraordinary Nursing Care. Every Patient. Every Time.