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Overview

Created on December 30, 2016

Issue

Alternate level of care (ALC) refers to a patient who is occupying a bed in a hospital but does not require the intensity of resources or services provided in this setting1. The Ontario definition was first standardized in 2009 by the Ministry of Health and Long-Term Care. Patients designated as ALC occupied 13.8% of all acute care beds across Ontario in 2015-162. The largest proportion of these patients were waiting for a long-term care bed3. The bottleneck posed by ALC patients occupying acute care beds poses a health system level problem as it affects a hospital's ability to care for acutely ill patients. It is recognized that a hospital by itself cannot improve this indicator. Cross-sector cooperation is needed to transition patients to the appropriate level of care in a timely manner.

Call to Action

The percentage of ALC days has shown some signs of improvement from 2011 to 20154. However, significant challenges remain as health care providers must focus on collaborative efforts to improve this indicator. Hospitals across Ontario have looked to reduce ALC days by following best practice care pathways, developing predictive models for length of stay, optimizing patient flow through huddles, and establishing cross-sector collaborations to remove barriers to discharge.

  1. Alternate Level of Care. 2016. Cancer Care Ontario.

    Available from: https://www.cancercare.on.ca/ocs/alc/

  2. Your Health System

    Canadian Institute for Health Information 2016.
    Available from: https://yourhealthsystem.cihi.ca/hsp/indepth?lang=en#/theme/C5001/2/N4IgWg9gdgpgIjALgQwJYBsDOBhRAndEALlBgA8AHZKAExhuPwFcYBfVoAA

  3. Alternate Level of Care (ALC) - September 2016.

    Access to Care. Cancer Care Ontario. Available from: http://www.oha.com/News/Documents/ALC%20Report%20-%20September%202016.pdf

  4. Measuring Up - 2016

    Health Quality Ontario. Available from: http://www.hqontario.ca/portals/0/Documents/pr/measuring-up-2016-en.pdf

Best Practices

Created on December 30, 2016

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.8 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Quality Based Procedure Handbooks - Ministry of Health and Long-term Care

  2. Alternate Level of Care. 2016. Cancer Care Ontario. Available from: https://www.cancercare.on.ca/ocs/alc/

  3. Your Health System. Canadian Institute for Health Information 2016. Available from: https://yourhealthsystem.cihi.ca/hsp/indepth?lang=en#/theme/C5001/2/N4IgWg9gdgpgIjALgQwJYBsDOBhRAndEALlBgA8AHZKAExhuPwFcYBfVoAA

  4. Alternate Level of Care (ALC) - September 2016. Access to Care. Cancer Care Ontario. Available from: http://www.oha.com/News/Documents/ALC%20Report%20-%20September%202016.pdf

  5. Measuring Up - 2016. Health Quality Ontario. Available from: http://www.hqontario.ca/portals/0/Documents/pr/measuring-up-2016-en.pdf

  6. Mekonnen AB, McLachlan AJ, Brien JA. 2016. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open 6(2):e010003 2016 Feb. 23

  7. Priority Assistance to Transition Home (PATH) Program - Canadian Red Cross / North East LHIN

  8. Meldon, S. W., Mion, L. C., Palmer, R. M., Drew, B. L., Connor, J. T., Lewicki, L. J., Bass, D. M. and Emerman, C. L. (2003), A Brief Risk-stratification Tool to Predict Repeat Emergency Department Visits and Hospitalizations in Older Patients Discharged from the Emergency Department. Academic Emergency Medicine, 10: 224–232. Available Here

  9. Patient Flow Toolkit - Saskatchewan Health Quality Council

Measurement

Created on December 30, 2016

“Some is not a number, soon is not a time.”
Don Berwick, former President and CEO of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator Indicator of Quality Improvement How to Calculate Targets/ Benchmarks How is This Indicator Used?
Process The total number of alternate level of care (ALC) days contributed by ALC patients within the specific reporting month/quarter using near-real time acute and post-acute ALC information and monthly bed census data See Indicator Library Targets: As low as possible (set by individual hospitals) QIP Priority Indicator


Tools & Resources

Created on December 30, 2016

Tools

Priority Assistance to Transition Home (PATH) Program - Canadian Red Cross / North East LHIN

Meldon, S. W., Mion, L. C., Palmer, R. M., Drew, B. L., Connor, J. T., Lewicki, L. J., Bass, D. M. and Emerman, C. L. (2003), A Brief Risk-stratification Tool to Predict Repeat Emergency Department Visits and Hospitalizations in Older Patients Discharged from the Emergency Department. Academic Emergency Medicine, 10: 224–232. Available Here

Patient Flow Toolkit - Saskatchewan Health Quality Council

QI Tools

For a more comprehensive list of tools and resources, visit the following links on our HQO website:

QI Resources