Healthcare Quarterly

Healthcare Quarterly 20(2) July 2017 : 37-43.doi:10.12927/hcq.2017.25226
Approaches to Alternate Level of Care

Six Change Ideas that Significantly Minimize Alternative Level of Care (ALC) Days in Acute Care Hospitals

Paula Chidwick, Jill Oliver, Daniel Ball, Christopher Parkes, Terri Lynn Hansen, Francesca Fiumara, Kiki Ferrari, Cindy Hawkswell and Karyn Lumsden


A significant issue affecting the healthcare system across Ontario is the number of patients admitted to hospitals that are then subsequently being designated alternate level of care (ALC). In 2016, 14.5% of Ontario in-patient beds were occupied by ALC-designated patients. Contributing to this phenomenon are ethical errors that can affect decision-making around discharge. Since 2012, William Osler Health System has redesigned their discharge process to eliminate ethical errors and align more fully with the Health Care Consent Act (HCCA) and the Public Hospitals Act (PHA). Through quality improvement processes including the use of scripting, education, checklists, mentoring and role clarity, Osler's ALC days are currently the lowest in the province of Ontario. The elimination of such errors also decreased patient confusion and improved the discharge experience.



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