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

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

Organizational
presence of
nursing

Nurse managed
dept.

May or may not be

formal nursing
structure

Workload
Bed capacity,
variability/intensi staffing

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.