Alternate level of care

All of us involved in the provision of care experience challenges with moving patients efficiently and effectively through our health care system. The term alternate level of care (ALC) is a clinical designation that identifies patients who no longer require the intensity of resources or services provided in their current settings and who are waiting for ALC. These patients often wait weeks, months, and sometimes years in acute and postacute hospitals for transfer to ALC settings; this in turn prevents other patients from accessing hospital beds, increases wait times in emergency departments and elective surgical cancellations, and limits hospital surge capacity.

According to the Canadian Institute for Health Information, from 2007 to 2008 ALC patients accounted for 5% of hospitalizations and 14% of hospital days in acute facilities across Canada, which equates to 5200 beds in acute care hospitals being occupied by ALC patients on any given day.1

The Ontario Ministry of Health and Long-Term Care is implementing a number of initiatives to reduce emergency department and ALC wait times; however, it is evident that in order to make substantial progress in this area we need more timely and reliable data on the wait times of ALC patients in all acute and postacute hospitals in Ontario. The first key step in the collection of these data is to ensure clinicians are designating patients as ALC consistently in all care settings across the province.

On behalf of the Ontario Ministry of Health and Long-Term Care and eHealth Ontario, the Wait Time Information Program at Cancer Care Ontario worked in close collaboration with health care stakeholders to develop a standardized Provincial ALC Definition. The definition is applicable across the continuum of care for all patient populations and provides guidance for clinicians on when to consider the designation of ALC for patients. On July 1, 2009, all acute and postacute hospitals in Ontario began using the standardized definition to designate patients as ALC, and the Wait Time Information Program continues to support their efforts to ensure the definition is applied consistently within their organizations.

As physicians, we need to continue to play a leadership role in supporting initiatives of this nature, as they will allow us to identify gaps in services and resources in our hospitals and communities, and will help us address the needs of our patients. Therefore, I encourage you to learn more about this important initiative and the steps Ontario is taking to reduce wait times and improve access to care for all patients.

For a copy of the Provincial ALC Definition, please visit www.cancercare.on.ca/ocs/alc; if you have any questions regarding this initiative, please e-mail ALCdefinition{at}cancercare.on.ca.

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