Alternate level of care (ALC)

Alternate level of care (ALC) is a designation used in Canada that is applied by clinical staff to that portion of a patient’s hospital stay when the patient is occupying a bed in a facility (e.g., acute care hospital) and does not require the intensity of resources or services typically provided in that care setting. (In other parts of the world ALC is often referred to as delayed discharge.)

There are several reasons that patients who have been designated to ALC continue to occupy a hospital care bed or use hospital resources. People may present to a hospital emergency department for nonacute medical or social reasons because of a real, or perceived, lack of access to more appropriate services (e.g., primary care, community supports). Patients may require new or additional services and be waiting for availability, such as home care or specialized care.

To address the challenges associated with ALC, we will explore strategies and initiatives that are being considered or implemented to enhance the infrastructure and support systems aimed at reducing ALC rates in Canada. This work builds on a previous request from a health care decision-maker for a report describing how health care centres or regions in Canada are handling ALC and any strategies they have found that successfully decrease hospital wait times or length of stay and increase patient flow. This work also builds on previous health systems work undertaken by Canada’s Drug Agency, including emergency department overcrowding and aging in place.

As part of this work, we aim to:

• identify and describe the most relevant reasons people in Canada are designated to ALC, describe the initiatives that are known to successfully address these reasons, and discuss considerations for the implementation of these initiatives
• provide trusted guidance to senior decision-makers to support evidence-informed and equitable initiatives to decrease ALC rates across jurisdictions in Canada.

Call for Statements of Interest