1. AMBULATORY CARE,ACUTE AND CRITICAL CAR
Presented by
Deepika R
M.Sc nursing I year
College of nursing
Madras medical college
Chennai-03

2.  INTRODUCTION
 Also referred to as outpatient care
 Many settings quality as outpatient centres such as
 Diagnostic centres
 Gastroenterology center
 Day surgery centers
 Medical treatment center
 Specific therapy or dialysis clinics

3.  Cont...
 Nursing home, home health care agencies provide many
other services.
 SERVICES PROVIDED BY HOME HEALTH
 TYPES OF SERVICES
 Physical services,
 Speech therapy,
 Occupational therapy,
 Social services,
 Home health aides,
 Home makers.

4. TYPES OF SERVICES DESCRIPTION
PHYSICAL SERVICES Therapist assesses the client ‘s mobility
after orthopedic surgery , injury or
stroke
He or she assess the need for assistive
devices .client must meet medicine
requirements to receive physical therapy.
SPEECH THERAPY Therapists provide rehabilitation of the
clients With speech or swallowing
disorders . client must meet medicare
requirements

5.  Cont....
OCCUPATIONAL THERAPY Assesses need for assistive devices
to aid in activities of daily living
and identify issues and related to
fine motor movements and
muscle retraining.
SOCIAL SERVICES Social workers meet with client and
family to identified the difficulties
with managing illness at home and
provide information about financial
assistance and community services.
HOME HEALTH AIDES Aides provide personal care such as
bathing and dressing and basic skills
such as taking vital signs.
HOME MAKERS Homemakers clean
,do dry laundry and shop for
groceries.

6.  Cont..
 including diagnosis, observation, consultation,
treatment, intervention, and rehabilitation services.
 This care can include advanced medical
technology and procedures even when provided
outside of hospitals.
 Ambulatory care sensitive conditions (ACSC)
 (ACSC) are health conditions where appropriate
ambulatory care prevents or reduces the need for
hospital admission (or inpatient care), such
as diabetes or chronic obstructive pulmonary
disease.

7.  Cont...
 Many medical investigations and treatments for
acute and chronic illnesses and preventive health
care can be performed on an ambulatory basis,
including minor surgical and medical procedures.
 Most types of dental services, dermatology services,
and many types of diagnostic procedures ,
 Blood tests,
 X-rays,
 Endoscopy and
 Biopsy procedures of superficial organs).

8.  Cont...
 Other types of ambulatory care services
include emergency visits,
 Rehabilitation visits, and
 In some cases telephone consultations.
 Ambulatory care services represent the most
significant contributor
 To increasing hospital expenditures and
 To the performance of the health care system in
most countries, including most developing
countries

9.  SCOPE
 Health care organizations use different ways to
define the nature of care provided as "ambulatory"
versus inpatient or other types of care
 Sites where ambulatory care can be delivered
include:
 Doctor's surgeries/Doctor's offices/General medical
practice: This is the most common site for the
delivery of ambulatory care in many countries, and
usually consists of a physician's visit.

10.  Cont...
 Physicians of many specialties deliver ambulatory care,
including specialists in
 Family medicine,
 Internal medicine,
 Obstetrics,
 Gynaecology,
 Cardiology,
 Gastroenterology,
 Endocrinology,
 Ophthalmology,
 Dermatology, and
 Geriatrics.


11.  Cont...
 CLINICS:
 Including
 Ambulatory care clinics,
 Polyclinics,
 Ambulatory surgery centers , and
 Urgent care centers.

12.  In the united states, the urgent care association of
america (UCAOA) estimates that over 15,000
urgent care centers deliver urgent care services.
 To evaluate and treat conditions that are not severe
enough
 To require treatment in a hospital emergency
department
 But still require treatment beyond normal
physician office hours or
 Before a physician appointment is available.

13.  CONT...
 In Russia and other countries of the former Soviet
Union, Feldsher health stations are the main site for
ambulatory care in rural areas.
 Hospitals
 Including emergency departments and other hospital-
based services such as same day surgery services and
mental health services.
 Hospital emergency departments:
 Some visits to emergency departments result in
hospital admission,

14.  CONT...
 so these would be considered emergency
medicine visits rather than ambulatory care.
 Most visits to hospital emergency departments,
however, do not require hospital admission.
 Non-medical institution-based settings:
 Including school and prison health; vision, dental and
pharmaceutical care

15.  Cont...
 Non-institution settings:
 For example, mass childhood immunization
campaigns using community health workers.
 Telematic
 Telemedicine is an expanding sector of ambulatory
medicine
 Aims
 To improve patient access to care; particularly
those living in remote regions.

16.  CONT..
 Studies have suggested that telemedicine can be
effective in delivering adequate patient care
including older adults.
 Due to the covid-19 pandemic, many countries
developed large scale telemedicine frameworks in
effort
 To continue outpatient assessments and follow-ups
across various specialties while minimizing the
spread of COVID-19.

17.  PERSONNEL AND MEDICAL EDUCATION:
 A nurse operating medical equipment in an
ambulatory care setting.
 Ambulatory care services typically consist of a
multidisciplinary team of health professionals that
may include (but is not limited to) .
 Physicians,
 Nurse practitioners
 Nurses,
 Pharmacists

18.  cont...
 Occupational therapists,
 Physical therapists,
 Speech therapists, and
 Other allied health professionals.
 Over the past decades,
 Internal medicine residency programs across north
america have made efforts to incorporate more
ambulatory training to the medical education
curriculum

19.  Cont..
 Training is focused on patient management
through multidisciplinary teamwork while creating
longitudinal continuity in patient care.
 TREATMENTS:
 Ambulatory care sensitive conditions (ACSC)
are illnesses or
 health conditions where appropriate ambulatory
care prevents or reduces the need for hospital
admission.
 Include one or more planned revisits to settings of
ambulatory care for follow-up,

20.  COMMON ACSC:
 Angina
 Asthma
 Cancer
 Chronic obstructive pulmonary disease
 Chronic pain
 Congestive heart failure
 Dental conditions
 Diabetes
 Dyslipidemia
 ENT (Ear-nose-throat) diseases

21.  Cont...
 Epilepsy
 HIV
 Hypertension
 Inflammatory bowel disease
 Influenza, pneumonia and other vaccine-
preventable diseases
 Iron-deficiency anemia
 Palliative care
 Pelvic inflammatory disease
 Thrombo embolic diseases
 Tuberculosis.

22.  SAFETY:
 There have been concerns regarding the safety of
ambulatory medicine.
 Missed appointments are common, costly, and can
lead to significant delays in both diagnosis and
treatment
 Advancements in information technology (IT) have
help to address some safety concerns of ambulatory
medicine
 minimizing mismanagement of electronic health
records (EHR),

23.  Ambulatory care nursing:
 Ambulatory care nursing is the nursing care of
patients who receive treatment on an outpatient basis,
 Ie they do not require admission to a hospital for an
overnight stay.
 Ambulatory care registered nurses provide care across
the life span to
 Individuals, families, caregivers, groups, populations,
and communities.

24.  Cont...
 Ambulatory care registered nurses interact with
patients during face-to-face encounters
 through a variety of telecommunication strategies,
often establishing long term relationships.
 telehealth nursing is an integral component of
professional ambulatory care nursing that utilizes a
variety of telecommunications' technologies during
encounters to assess, triage, provide nursing
consultation

25.  TELEHEALTH NURSING:
 An integral component of professional ambulatory
care nursing .
 Utilizes a variety of telecommunications' technologies
during encounters
 To assess, triage,
 Provide nursing consultation.
 Perform follow up and
 Surveillance of patients status and outcomes.

26.  Ambulatory care registered nurses,
 Acting as partners and advisers,
 Assist and support patients and families to optimally
manage their health care,
 Respecting their culture and values, individual needs,
health goals and
 Treatment preferences.

27.  cont....
 ACRN
 Administer, and
 Evaluate nursing services within the organization in
accord with relevant federal requirements, state laws
and
 Nurse practice acts, regulatory standards, and
institutional policies and procedures.

28.  ACUTE CARE:
 Acute care is a branch of secondary health care where
a patient receives active but short-term treatment for a
severe injury or episode of illness, an urgent medical
condition, or during recovery from surgery
 Acute care services are generally delivered by teams
of health care professionals from a range of medical and
surgical specialties.

29.  CONT...
 Acute care settings include
 emergency department,
 intensive care,
 coronary care,
 cardiology,
 neonatal intensive care, and many general areas

30.  Where the patient could become acutely unwell and
require stabilization and
 Transfer to another higher dependency unit for further
treatment.

31.  DOMAINS:

32.  EMERGENCY CARE:
 Means a fire, a flood, extreme weather, a missing
person situation, or
 A natural or
 Man-made disaster, or
 A circumstance that presents an imminent threat.

33.  Emergency Department:
 Chest pain or pressure
 Compound fracture (bone that protrudes through
the skin)
 Head injuries
 Pneumonia
 Seizures
 Severe abdominal pain
 Shortness of breath
 Sudden, severe headache, or paralysis or weakness
 Uncontrolled bleeding

34.  URGENT CARE:
 Care for an illness,
 Injury or
 Condition serious enough that a reasonable person
would seek care right away,
 But not so severe it requires emergency room care.

35.  Urgent Care clinic:
 Back or muscle pain
 Bronchitis
 Cuts and minor burns
 Diarrhea
 Earache
 Skin conditions
 Sprains or joint pain
 Upper respiratory infection
 Urinary tract infections
 Vomiting

36.  SHORT-TERM STABILIZATION:
 It's a short period of time where a client can come
to our facility to be medically stabilized.
 We make sure that all of our clients are safe and
comfortable the this process.
 Short-term stabilization requires medical and
psychiatric evaluations and care.

37.  CONT...
 Stabilization that is short-term is more specific and
 Generally refers to care provided for patients
struggling with a mental health crisis or
 An addictive disorder.
 Example: A person struggling with an eating disorder.
Short-term stabilization can ensure the patient gets
adequate nutrition and medical care so that long-term
mental health care can begin.

38.  CONT...
 Short-term stabilization can ensure the patient gets
adequate nutrition and medical care
 so that long-term mental health care can begin.

39.  PRE HOSPITAL CARE
 Pre-hospital emergency
medicine (abbreviated PHEM),
 Also referred to as pre-hospital immediate care, or
 Emergency medical services
medicine (abbreviated EMS medicine).

40.  Cont...
 Medical subspecialty
 Which focuses on caring for seriously ill or
 Injured patients before they reach hospital, and
 During emergency transfer to hospital or between
hospitals.

41.  It may be practised by physicians from various
backgrounds such as
 Anaesthesiology,
 Emergency medicine
 Intensive care medicine and
 Acute medicine.

42.  CRITICAL CARE
 Critical care is medical care for people who have
life-threatening injuries and illnesses.
 It usually takes place in an intensive care unit (icu).
 A team of specially-trained health care providers gives
you 24-hour care.
 This includes using machines to constantly monitor
your vital signs.

43.  Who needs critical care?
 Severe burns
 COVID-19
 Heart attack
 Heart failure
 Kidney failure
 People recovering from certain major surgeries
 Respiratory failure
 Sepsis

44.  CONT...
 Severe bleeding
 Serious infections
 Serious injuries, such as from car crashes, falls, and
shootings
 Shock
 Stroke

45.  EQUIPMENTS:
 Catheters, flexible tubes -drain fluids from the body
 Dialysis machines ("artificial kidneys") -kidney failure
 Feeding tubes, - nutritional support
 Intravenous (IV) -fluids and medicines
 Monitors-diplay vital signs
 Oxygen therapy-oxygen to breathe
 Tracheostomy -breathing tubes. The tube is placed in a
surgically made hole that goes through the front of the
neck and into the windpipe.
 Ventilators (breathing machines)

46.  Treatments and Therapies
 Arterial catheterization
 Central venous catheter (central line)
 Chest tube insertion - slideshow
 Chest tube thoracostomy
 Tracheostomy - slideshow
 Ventilator

47.  LEVELS OF CARE:
 Level 1—
 Ward based care
 where the patient does not require organ support (for
example, they may need an IV, or oxygen by face mask)
 Level 2—
 High dependency unit (HDU).
 Patients needing single organ support (excluding
mechanical ventilation)

48.  CONT...
 such as renal haemofiltration or ionotropes and
invasive BP monitoring. They are staffed with one
nurse to two patients
 Level 3—
 Intensive care.
 Patients requiring two or more organ support (or
needing mechanical ventilation alone).
 Staffed with one nurse per patient and usually with a
doctor present in the unit 24 hours per day.