The following information is for healthcare professionals and administrators.

On July 1, 2009, all acute and post-acute hospitals in Ontario began using a standardized Provincial Alternate Level of Care (ALC) Definition to designate patients ALC.

Why we need a standardized definition

Having a standardized ALC definition will help achieve the goals of the Provincial ER/ALC Information Strategy. It is an important step toward capturing high-quality and near real-time data on all patients waiting in acute and post-acute hospitals for alternate levels of care. This data will help improve patient flow and reduce ER (emergency room) wait times, and inform decisions about the allocation of resources.

Who contributed to the definition

This definition was approved by the Ministry of Health and Long-Term Care in March 2009. It was developed in consultation with stakeholders from across the continuum of care, including:

• Acute and post-acute hospitals (i.e., complex continuing care, mental health and rehabilitation)
• Community Care Access Centres (CCACs)
• Ministry of Health and Long-Term Care (MOHLTC)
• Local Health Integration Networks (LHINs)
• Canadian Institute for Health Information (CIHI)
• Ontario Hospital Association (OHA)
• Ontario Health Quality Council (OHQC)

Cancer Care Ontario’s role

The Wait Time Information Program (WTIP) at Cancer Care Ontario has been asked to lead the adoption of the Provincial ALC Definition, and to support all acute and post-acute hospitals in Ontario as they apply it.

Questions?

For details about upcoming activities, or to get answers to your urgent questions, please email ALCdefinition@cancercare.on.ca .

Provincial ALC Definition

The healthcare system aspires to deliver care in a setting that is congruent with the clinical needs of a patient as defined by the patient’s health status, treatment plan and goals.

The definition applies to all patient populations waiting in all patient care beds in an acute or post-acute care hospital in Ontario.

Definition: When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate Level of Care (ALC)¹ at that time by the physician or her/his delegate. The ALC wait period starts at the time of designation and ends at the time of discharge/transfer to a discharge destination² (or when the patient’s needs or condition changes and the designation of ALC no longer applies).

Note 1: The patient’s care goals have been met or progress has reached a plateau or the patient has reached her/his potential in that program/level of care or an admission occurs for supportive care because the services are not accessible in the community (e.g. “social admission”). This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Note 2: Discharge/transfer destinations may include, but are not limited to: home (with/without services/programs), rehabilitation (facility/bed, internal or external), complex continuing care (facility/bed, internal or external), transitional care bed (internal or external), long term care home, group home, convalescent care beds, palliative care beds, retirement home, shelter, supportive housing. This will be determined by a physician/delegate, in collaboration with an interprofessional team, when available.

Final Note: The definition does not apply to patients: waiting at home, waiting in an acute care bed/service for another acute care bed/service (e.g., surgical bed to a medical bed), waiting in a tertiary acute care hospital bed for transfer to a non tertiary acute care hospital bed (e.g., repatriation to community hospital).