A growing volume of care can be delivered on a walk-in-walk-out basis or with short-stay admissions. This will help shape the new hospital and its relationship with the wider health system.

 

What is ambulatory health care?

In essence, what is termed ambulatory care is health care that doesn’t require an overnight admission to hospital. The term includes out-patient and day care.

It is provided during “office hours” and can include diagnosis, observation, consultation, performance of medical procedures, day surgery and rehabilitation services.

An increasing amount of ambulatory care can be provided outside hospitals.
Most ambulatory care is non-urgent but it can encompass some urgent cases.

What are the trends in this type of health care?

A huge growth in ambulatory medicine has occurred over the past 20 to 30 years due to improved technology and enhanced systems for patient care.

Patients have a strong preference for care which does not require an overnight hospital admission.

The spectrum of this care extends from the patient’s home through to a day facility either in the community or in a hospital.

The planning for a contemporary hospital has to take into account the large volume of care which can be delivered on an ambulatory or day basis.

What are the potential benefits of ambulatory and short stay care?

• Care is more accessible
• The care environment is more congenial and more aligned with normal life
• Appointments can be coordinated at a time that suits the patient
• Less disruption to everyday life
• Reduction of waiting times for outpatient care and surgery
• Reduced demand on ED and in-patient beds
• Reduced risk of acquiring hospital based infection
• Better coordination with community health teams
• Fewer cancellations

What might patients experience?

1. Hospital in the home – health services for an increasing number of conditions can be taken to the patient in their own home. This could be supported by video consultations and home monitoring devices.

2. Community medical centres – these centres are run by community health providers. These centres can contain procedure rooms allowing performance of minor surgery and other procedures. A working example of this concept is the Wanaka Medical Centre.

3. Community-based centres managed by the SDHB – a number of clinical services have undergone a transition whereby the majority of their clinical activity is now delivered in an ambulatory setting, for example, mental health. This includes both medical and surgical services. To achieve efficiencies of scale it is ideal that a number of SDHB services are grouped together.

4. Hospital-based ambulatory care centres – a facility close to but separate from the acute hospital providing a range of services which can include out-patient clinics, elective day surgery and procedures, medical procedures, minor injury care, wound care, cancer care, dialysis training, rehabilitation and modern diagnostic facilities. Ambulatory care centres are an important link to community care networks.

5. Short stay/planned procedure units – Day surgery and day procedures are the main focus. These units are designed to be high volume and experience has shown that improvements occur in access to elective surgery and efficiency of theatre and bed use. Connections with community services are strong.

What are the implications for community services?

Since ambulatory care is oriented towards the community, it is essential that links to clearly defined community networks of care are identified.

Communications within this network will need to be better than the traditional hospital-community connection.

This Q and A is based on a position paper produced by the New Dunedin Hospital project's Clinical Leadership Group

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