Peter Chiira

 Ambulatory Care Project Name Institution Ambulatory health care is a type of care given to patients who are confined to a bed in a health facility at the time the care is rendered (McWay, 2013). It is the care provided to an individual in an outpatient setting. The primary feature of this care is that the patient travels to or from the hospital setting on the same day without being admitted as an inpatient. The patient is assessed, diagnosed, treated and permitted to go home on the same day without the need to be admitted at the facility overnight. Since the patient the patient is not admitted to the hospital, this type of care is also known as outpatient care. The health care sector offers ambulatory in several diverse settings. This paper discusses the ambulatory care setting of urgent care clinics, its significance in health care, how the setting was developed, trends associated with the context, its potential impacts on health care and recommendations for staffing policies. Introduction and significance of this ambulatory setting to the health care delivery system Urgent care clinics are medical centers that provide acute episodic care to patients who are not scheduled (McNeeley, 2012). The importance of this setting in the health care delivery system is that in addition to offering unscheduled care, the setting also access after normal hospital operating hours, better services than the primary care and cheap care. Urgent care clinics are open at least twelve hours a day and open during weekends (Weinick & Betancourt, 2007). This characteristic allows patients who required primary care but would not have accessed it because the facilities offering the care were closed to access treatment and manage the condition before they could access a primary care physician. The significance of this ambulatory setting to the health care delivery system is that it helps to bridge the extended gap between patients’ access to primary care and emergency care. The setting also addresses the country’s shortage of primary care providers and changes the way primary care has been offered in the past. Before the emergence of urgent care clinics, primary care was less during the evening and on weekends causing a gap in the provision of attention. The hospitals have filled that gap and offer primary care during these times, a trend that has attracted more patients to use urgent care clinics. Another significance of this setting is that it treats patients who do have the financial capability to meet the high cost of emergency department care for non-emergent issues (McNeeley, 2012). Insurers and employers who pay insurance premiums mostly direct patients to find urgent care clinics rather than emergency rooms. Another significance of this ambulatory setting is that it decreases the use of non-urgent emergency department use without increasing hospitalizations (Weinick, Bristol, & DesRoches, 2009). The urgent care clinics are independent of the primary care settings and provide medical care for the patients seeking attention for acute conditions that are not very severe to require the attention of emergency department services. Why and how this setting developed in the healthcare system The concept of urgent care in the country started in the early 1980s and had been operating since then. After the mid-1990s, this ambulatory care setting started growing rapidly and to between four thousand to nine thousand new clinics established since then according to data collected by the industry’s association (Urgent Care Association of America, 2011). The first reason why this setting developed in the health care system was the shortage of primary care physicians in the system. The patients had been waiting for too long for doctor appointments, and the urgent care clinic was opened to bridge this gap by providing medical care for the acute condition. The second reason responsible for the development of the urgent care clinic setting is that the emergency centers in the country have been operating at or over capacity for years. The burden and excessive pressure on the emergency departments created the need for an ambulatory setting that could relieve the excess pressure by treating cases that were not severe for emergency care. A previous study found out that 27.1 percent of the cases at the emergency departments could be treated at the urgent care clinic settings (Braidish, 2014). The crowding at the emergency centers threatens the capacity of the practitioners to administer convenient care that worsens the condition and prolongs the pain and suffering of the patients. Some of the patients whose conditions are not severe may worsen because of waiting for too long. The urgent care setting emerged to cater for such cases and offer timely care. On the issue of how the setting developed in the healthcare system, the characteristic of offering same day services and shorter wait times was a major attraction (Braidish, 2014). This ambulatory care setting provides quicker access to medical care with shorter wait times than other ambulatory care settings like emergency rooms and physicians’ offices. The ability to acquire quick health services without having to wait for long have been attracting more people to seek their services, which have in turn caused the increase in the number of these clinics. This setting appeals to the patients whose work schedules cannot allow them to make physician appointments during the traditional business hours or on weekends. The urgent care setting offers offer convenience that primary care offices cannot provide due to limited operating hours and large patient volumes. Current trends associated with urgent care clinics ambulatory setting One of the main trends in urgent care is the ownership of urgent care clinics. In the past, urgent care clinics were autonomously owned, and independent offices but the control environment have evolved considerably. The change has shifted from independent and autonomous to a situation where several large urgent care clinics operate in some regions. In addition, some hospitals have also started establishing their urgent care clinics as a strategy to expand their service and referral bases (Yee, Lechner, & Boukus, 2013). Another trend related to this is that insurers have also started partnering with other medical facilities to establish urgent care centers were a way of controlling spending growth. This strategy by the insurers controls spending growth by shifting some of the medical services from the emergency departments to the lower cost urgent care facilities. The primary reason why hospitals are currently establishing their centers is that they use it as a way of retaining their current patients and acquire new ones through the provision of additional and more convenient access. Another current associated with this setting is that market dynamics influence the location of these clinics. Most of the urgent care clinics are located in the more populous higher income areas. The stakeholders in this industry state that the strategic locations of this ambulatory care setting are the places with high traffic and foot traffic and visible from the main roads. There is also a tendency to locate these clinics in more-affluent areas where there is a high concentration of people who are employed. The reason why the current clinics are located in estates and parts of towns with large number of residents is to capture large volumes of clients to allow them to break even (Yee, Lechner, & Boukus, 2013). The other trend associated with this setting is that is the race by nonmedical investors to invest in urgent care and medical services. Some of these investors are private equity investment firms. These investors have sensed an opportunity to earn profits and have been investing billion on to the setting. The approach used by these investors is treating as in shortest time possible and as urgent care have low profits but large number of clients. The higher the patients served with in a day, the higher the amounts earned. Another reason that attracts investors into this business is that urgent care clinics can pick their patients as most do not serves patients insured by Medicaid and do not treat those with no insurance unless they pay before the offering of the service (Creswell, 2014). Potential impact urgent care setting could have on health care delivery in the future The health care sector is turning towards a timely care and outpatient form with a broad range of services to suit the diverse customer inclinations. To meet these consumer likings for care the medical associations, health organizations, and other agencies are directing their efforts towards developing outpatient centers to offer services and amenities (Merritt Hawkins, 2015). Urgent care centers are one of those outpatient centers. The urgent care clinics will affect the health care delivery system by providing sufficient outlets for offering outpatient to the increasing number of citizens seeking medical services. The ambulatory setting will also change the health care delivery system in the future by bridging the gap created by a shortage of physicians in the country. The results of this gap in the sector are that it most patients are forced to wait for several hours or days to obtain the services of a physician. Most of the patients are not willing to wait for a long to see a doctor. Visiting an urgent care clinic will in future offer an option that appropriately matches the program of the patient. In addition, the clinics will provide unrivaled success to family practitioners and internal medicine specialists, which are specializations that are in inadequate supply in the country. Urgent care clinics offer convenient, cheap, convenient, low-cost primary care treatment, screening, and diagnostic services as an ambulatory setting. In future, these settings will be an vital section of the country’s health system as the country moves towards improving patient care and population health at reduced costs. The urgent care clinics will also affect the healthcare delivery system by seeking to prevent hospital admissions. In the current world, patients are concerned with access to medical care more than the quality of the care. Due to this perspective, several patients consider fast care as the best care. The health sector also understands that identifying the individuals whose conditions is deteriorating and that need urgent intervention, offering this quick care within the shortest time possible can have a significant affect the entire health delivery system by reducing the cases of avoidable emergency hospital admissions. Recommendations for staffing and policies The first recommendation on policies for an urgent care clinic is to embrace a safety culture in the clinic. The administration and the physician should model the practices at the clinic towards the security of employees and patients. In addition, the administrator should also ensure that the clinic is up to date about regulation from the accrediting bodies and offer the necessary training to the staff and providers (Disraeli, 2009). The second policy recommendation would be utilizing unique patient identifiers to identify the patients properly before performing procedure, drawing blood and administering the different types of medicines. The importance of this practice is to avoid mixing up of blood samples of giving the wrong drugs to patients as a way of ensuring patient safety. The common types of identifiers are first and last names and dates of birth. The third recommendation concerns staffing, and urgent care clinics should have to use the physician-based staffing model that uses physicians certified by the concerning bodies like family doctors and pediatricians. The other types of staff that can work in the urgent care settings include physician assistants and nurse practitioners who can work with the doctor or work independently according to their scope of practice. The author recommends a combination of all these three types of staff to work at the urgent care clinic at the same time. The oversight bodies must first license these professionals. The fourth recommendation is that the staff size selected for the urgent care clinic should be large enough to cover the patient visits and have the necessary expertise to treat all the disorders. The staff plan must also include variables to cater for particular seasons like cold and flu season (AMN Healcthcare, 2015). Adequate staffing is a critical aspect that helps in meeting patient expectation in urgent care services. The staffing plan can also state how the clinic will use a mix of permanent and temporary staff to deal with excess patients’ demand and shortage of professionals. The reason why a staffing plan is critical in a fast growing environment like urgent care is that it helps in reducing the challenges of shift schedules and prevents staff burnout. The clinic can avoid these problems while minimizing costs, decreasing the probability of the occurrence of adverse events and improving client satisfaction. Conclusion The ambulatory care refers to the services offered to a patient when he or she is not confined to a hospital bed at the time the health service is offered. One of the ambulatory care settings is urgent care clinics that provide health services to unscheduled patients. This importance of this setting is that it provides care to the patients who have are not able to receive scheduled care from their physicians. This setting provides care during the periods not provided by primary care settings like during weekends. The reason why the setting developed in healthcare delivery system is to reduce the burden on the country’s emergency services by treating the less severe cases. The current health care is shifting towards an available and outpatient model, and the setting will be critical in providing adequate outlets for providing the outpatient care and reducing the number of hospital admissions. This setting will also influence the health care delivery system in future by offering quick and low-cost services. References AMN Healcthcare. (2015). Urgent care staffing . AMN healthcare . Braidish, J. (2014). Urgent- care centers grow in number. St Louis Metropolitan Medicine, 13-16. Creswell, J. (2014, July 9). Race Is On to Profit From Rise of Urgent Care. Retrieved from New York Times: https://www.nytimes.com/2014/07/10/business/race-is-on-to-profit-from-rise-of-urgent-care.html?_r=0 Disraeli, P. (2009). Toward Ensuring Patient safety in urgent care. The Journal of urgent care medicine, 11-23. McNeeley, S. (2012). Urgent Care centers: an overview. American Journal of clinical medicine, 80-81. McWay, D. C. (2013). Today's Health Information Management: An Integrated Approach. Boston: Cengage Learning. Merritt Hawkins. (2015). Convenient care: growth and staffing trends in urgent care and retail medicine. AMN healthcare, 1-15. Urgent Care Association of America. 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