Complete guide to Canadian hospital patient flow — access block management, ALC (Alternate Level of Care) patients, discharge planning, bed management, provincial flow strategies, and patient flow software.
ALC patients occupy 15-25% of Canadian hospital beds. Access block affects 20-30% of admitted ED patients. This guide covers Canadian patient flow.
Patient Flow Components
| Stage | Description | Key Metric |
|---|---|---|
| Admission | ED to inpatient bed | Door-to-bed time |
| Inpatient stay | Acute care treatment | LOS vs expected |
| ALC | Waiting for alternate care | ALC days |
| Discharge | Discharge from hospital | Discharge time |
| Post-discharge | Home, LTC, rehab | Readmission rate |
ALC Management
- ALC identification: Identify ALC patients early (daily review)
- Placement planning: Plan placement (LTC, home care, rehab) from day 1
- ALC coordinator: Dedicated ALC coordinator to manage placements
- Home care packages: Arrange home care packages for eligible patients
- LTC placement: Fast-track LTC placement for ALC patients
- Transitional care: Use transitional care units for ALC patients
- Family communication: Communicate with families about placement options
- ALC reporting: Report ALC days to CIHI and provincial health ministry
Discharge Improvement
- Discharge by noon: Target 30%+ of discharges before noon
- Discharge planning: Start discharge planning on admission
- Medication reconciliation: Reconcile medications at discharge
- Discharge summary: Complete discharge summary within 48 hours
- GP notification: Notify GP of discharge and follow-up needs
- Follow-up appointment: Arrange follow-up before discharge
- Patient education: Educate patient about post-discharge care
- Post-discharge follow-up: Phone follow-up within 48 hours
Frequently Asked Questions
- What is ALC in Canadian healthcare?
- ALC (Alternate Level of Care) refers to hospital patients who no longer need acute care but remain in hospital waiting for placement elsewhere (long-term care, home care, rehabilitation). ALC patients occupy 15-25% of Canadian hospital beds. ALC is a major cause of access block and ED overcrowding. Solutions: 1) Long-term care placement, 2. Home care packages, 3. Transitional care, 4. Rehabilitation beds.
- What is access block in Canadian hospitals?
- Access block is when admitted ED patients cannot access inpatient beds. Access block affects 20-30% of admitted Canadian ED patients. Average wait: 10-20 hours. Causes: 1) ALC patients occupying beds, 2. Hospital overcrowding, 3. Insufficient beds, 4. Discharge delays. Access block increases ED wait times, patient mortality, and staff stress.
- How do Canadian provinces address patient flow?
- Canadian provincial patient flow strategies: 1) ALC placement teams, 2. Discharge-by-noon campaigns, 3. Home care expansion, 4. Long-term care bed expansion, 5. Virtual wards and hospital-at-home, 6. Transitional care units, 7. ED flow improvement programmes, 8. Provincial patient flow dashboards. Some provinces have dedicated patient flow funding.