Alternate Level of Care in Canada: Evidence Assessment Report

Key Messages

• 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 as 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 designations, we explored 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.