All Outpatients Are Not the Same

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Winter 2009
www.spacemed.com

BACKGROUND
There is a tendency to simplistically divide a healthcare organizations customers
into inpatients and outpatients. Inpatients vary from the acutely-ill with life threatening conditions to the short-stay patient undergoing a routine procedure. Outpatients
also have different needs and expectations depending on their acuity and the
nature of the care that they require. At the same time, the distinction between an
inpatient and outpatient is blurring with new care delivery models, alternate care
settings, and technological advances. Today, unless admitted through the emergency department, most patients arrive at the hospital as an outpatient and are
generally admitted post-procedure. With the trend toward minimally-invasive surgery and shorter lengths of stay, the only difference between an inpatient and an
outpatient may be the length of their recovery four, six, eight hours versus a 30hour stay or discharge the next day. These patients require the same preprocedure preparation, experience the same reception and intake processes, and
require the same pre-discharge instructions regardless of whether they are classified as an inpatient or an outpatient.
UNDERSTANDING THE DIFFERENT TYPES OF OUTPATIENTS
There are also different types of outpatients (as shown in figure on the following
page) ranging from those seeking care for life-threatening conditions to those
focused on fitness or wellness, with the various types of outpatients in between:

2009.2.1

Life threatening or emergent care that requires immediate treatment

for life-threatening or urgent conditions as well as care for patients who
consider themselves to be in immediate need of medical care.

Routine/episodic care which may involve an occasional or once-a-year

visit to the healthcare campus for routine care such as an annual
physical or a chest X-ray.

Acute ambulatory/short-stay care that may involve a once-in-a-lifetime

experience such as outpatient surgery or an outpatient cardiac
catheterization.

Chronic or recurring ambulatory care involving frequent or ongoing

visits multiple times per week or month for services such as
physical therapy, cancer care, and dialysis.

Fitness or wellness activities that may include exercise regimens and

health education for individuals who do not perceive themselves as
patients.

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All Outpatients Are

Not the Same
Continued

COMMONLY REFERRED TO AS OUTPATIENTS

LifeThreatening/
Emergent
Care

Routine/
Episodic Care

Urgent care
Physician office visit
Routine/express
testing:
Specimen
collection
EKG
Routine imaging
Ultrasound
Pre-admit services

Acute Ambulatory/
Short-Stay Care

Surgery
Endoscopy
Cardiac cath/
invasive cardiology
Specialty imaging
Other observation/
short-stay services

Chronic/Recurring
Ambulatory Care

Fitness/
Wellness

Physical rehab
Cardiac rehab
Chronic dialysis
Infusion/chemotherapy
Radiation therapy
Behavioral health

CONCLUSION
Each type of outpatient has different needs and expectations relative to site
access and wayfinding, convenience, recognition by staff, and discharge instructions. The sharing of space by different types of outpatients also needs to be
considered. Viewing recovering patients exercising in a cardiac rehab area may
be inspirational and reassuring for a patient undergoing a heart catheterization or
pre-surgery testing for open-heart surgery. However, it may not be advisable to
mix patients undergoing chemotherapy with healthy patients undergoing annual
health screening procedures.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

2009.2.1

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