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
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Ambulatory Care Defined
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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
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Ambulatory Patient Characteristics
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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
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University hospital
outpatient
Community hospital
outpatient
Solo & group medical
practices
HMO
Government health
systems
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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
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Kaiser Permanente is America's largest not-for-profit
health plan
It includes
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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 familyInput from nurse
Primary
Intervention Mode
Direct
Consultative
Nurse managed
Organizational
presence of nursing dept.
May or may not be
formal nursing
structure
Bed capacity, staffing Scheduling system,
Workload
variability/intensity ratios
Ambulatory Care Nursing Administration
and Practice Standards, 2007
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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.”