A patient is designated ‘alternate level of care’ (ALC) when they are occupying a bed in a hospital and do not require the intensity of resources/services provided in this care setting. Reducing ALC rates is an important priority in Ontario. Read the Alternate Level of Care Reference Manual released by Access to Care (Cancer Care Ontario) for a full provincial definition of ALC.
A designation of ALC can have negative effects on both the patient (for example, through risk of hospital-acquired infections and functional decline while in hospital) and the health care system (for example, through high costs and limiting access to acute services for patients who truly require them). In addition to the effects on patients and the health care system, an ALC designation can also lead to stress and uncertainty for family caregivers. Read this study by Kuluski et al (2017), which aimed to investigate the experience of carers (such as family members) of patients at three hospitals in Northwestern Ontario who were designated ALC while waiting for long-term care.
There is considerable work going on to address ALC in this province, including through collaborative efforts within Ontario’s 14 local health integration networks (LHINs). The Toronto Central CCAC (now the Toronto Central LHIN) published a document titled ALC Avoidance Leading Practices and Improvement Strategies for the Acute Care Sector in 2015, which was prepared in collaboration with the hospitals in this LHIN. The Toronto Central LHIN’s approach is also described in this article by Burr and Dickau (2017), which includes three case reports.
Runnymede Healthcare Centre, a complex continuing care and rehabilitation centre in the Toronto Central LHIN, is another organization in the Toronto Central LHIN that has achieved significant improvements in their ALC rate. We reached out to a team from Runnymede to find out more about this work – read the interview here.
In the Central West LHIN, Chidwick et al (2017) wrote about six change ideas that significantly minimize ALC days in acute care hospitals, drawing from their experience reducing the ALC rate at William Osler Health System.
Have you been involved in any of the approaches described in these publications? How do you think we can best address high ALC rates in Ontario? Comment below to share your thoughts.