1. Ambulatory Care

2. 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

3. 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

4. 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.

5. Current Trends Impacting Ambulatory Care Increasing life expectancy Environmental threats Increased legislation & regulation Technological Advances (clinical & non- clinical) Consumer awareness

6. 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

7. 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

8. 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

9. Inpatient Practice vs. Ambulatory Practice Aspect of Role InpatientAmbulatory Treatment episode InpatientVisit/phone/email Observation mode Direct & continuousEpisodic Management of treatment plan Nurse - Input from patient &/or family Patient &/or family- Input from nurse Primary Intervention Mode DirectConsultative Organizational presence of nursing Nurse managed dept. May or may not be formal nursing structure Workload variability/intensity Bed capacity, staffing ratios Scheduling system,

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

11. Kaiser Permanente Nursing Vision and Model “Extraordinary Nursing Care. Every Patient. Every Time.”