South East LHIN providers work together to address Emergency Department/Alternate Level of Care issues
When it comes to being able to provide patients with the right care in the right place at the right time, the South East region has significant opportunity for improvement.
According to a survey conducted by the Ontario Hospital Association in November 2008, 18 percent of acute bed days are being used to care for alternate level of care (ALC) patients.
Mostly, these are people who cannot be discharged from hospital because they are awaiting another type of care elsewhere. These patients deserve access to the services they require as do those awaiting admission to hospital through Emergency Departments (EDs) or scheduled surgeries who cannot get in because there are not enough available beds.
Despite many strategies to find ways to place ALC patients more appropriately in the community, we clearly need a coordinated, system-wide approach that involves all stakeholders dedicating resources and energy to working together.
About the ED/ALC issue
|What does Alternate Level of Care (ALC) mean?
||Patients in an acute hospital bed should be there because they need acute care services such as intensive treatment for an illness, recovery from surgery or injury.
Once their acute need has resolved, they may require a different kind of care (ie rehabilitation) before they can return to their previous living arrangement or perhaps their illness or injury may require them to seek a different type of housing in future (e.g. retirement or perhaps long-term care homes).
Therefore, a patient is generally defined as "ALC" if they have completed their acute phase of care and they would be better cared for in a different setting.
Patients who are identified ALC need to be better supported within our system, We also recognize that the impact of ALC days is a serious, system-wide issue that has a significant impact on the health care system, as acute care beds are needed by those who are awaiting admission to hospital.
|How many ALC patients are there in the South East? How does this compare to the rest of Ontario ?
||From January to December 2007, 17% of the total patient days spent in acute hospital beds involved ALC patients. The provincial target is: 9.46%. The SE LHIN has committed to reduce these ALC levels to 14% by March 2009 and to 13% by March 2010.
|Tackling the problem from a provincial perspective.
||On May 30, 2008, the Ontario Ministry of Health and Long-Term Care announced its ED/ALC Strategy. This investment includes a number of components including additional funding for Emergency Departments facing the greatest wait time pressures; increased funding and flexibility for home care services through the CCAC, priority funding for the LHIN itself to invest in local solutions to further address ALC pressures. The work on these initiatives is moving forward and they will be rolled out over the upcoming weeks.
|What is the South East LHIN doing about ED/ALC?
||In September, the SE LHIN, hospital and Community Care Access Centre (CCAC) chief executive officers committed to work closely to tackle the ALC issue from a regional system perspective, resulting in the ED/ALC Initiative. Led by a Working Group that includes community stakeholders in addition to LHIN, hospital and CCAC representation, the mandate is to implement innovative change across the region. The Working Group has the authority to direct changes that will reduce use of acute hospital bed days by patients designated as ALC to 14.1 percent by March 31, 2009.
This group will build upon and support ongoing strategies including:
- An Eldercare Access Strategy in Emergency Rooms (EASIER+) at QHC and Kingston General. It involves increased services to support seniors returning home where appropriate and avoiding future admissions. This program was profiled in Kingston Life magazine.
- Physical activation programs and increased physio and occupational therapy interventions early in hospital admissions.
- The Transitions Initiative, a collaborative project led by the Health Care Network with hospitals, CCAC and long-term care looking at a number of areas related to the ALC issue.
- The region’s SMILE program operated through the VON that provides supports to frail elderly to enable them to remain in their homes.
- Click here for the LHIN’s comprehensive 2009/10 ED/ALC plan.
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