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 Role Inpatient

Ambulatory

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, staffing
ratios
Scheduling system,
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.