ambulatory care

ambulatory, acute and critical care

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.