Hospital patients who require an alternate level of care | HQCA Focus

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Hospital patients who require an alternate level of care

Percentage of time a hospital’s beds are occupied by patients who require an alternate level of care (for example, continuing care). (see data dictionary)

Alberta Health Services, Analytics. “Provincial ALC Statistics.” (2018) [Dashboard showing monthly and quarterly results for the percentage of time a hospital’s beds are occupied by patients who require an alternate level of care, by zone and facility].  AHS Tableau Reporting Platform. Retrieved from

What do you see?

  • Are there any trends over time? When the percentage of time in this chart decreases, it means more patients are being cared for in the right place for the right amount of time. If the percentage of time increases, it means there could be a need to explore how to free up hospital beds by moving patients more quickly to other, more appropriate, care settings.
  • Does the percentage differ between cities? Why might some cities have generally lower percentages than others?

Why is it meaningful?

  • Is there a relationship between this data and another healthcare area?
  • Do you see successes worth highlighting or opportunities for improvement?

Understanding the "alternate level of care percentage"

While this chart is about patients who are in the hospital, not in the emergency department, it provides important information that can impact patients in the emergency department. It also provides insights into how Alberta is doing at managing overall bed capacity in the healthcare system.

When emergency department patients who are admitted to the hospital don’t leave emergency for a hospital bed right away, it is because there are no hospital beds available. One of the reasons a hospital’s beds may be fully occupied is because the beds are being used by patients who no longer require hospital care, but can’t go home. These patients may need a different level of care that is better suited to their changed medical needs. Often, these are patients waiting for a room in continuing care.

The alternate level of care percentage can impact hospital occupancy. Also, if the alternate level of care percentage is increasing, it is likely that other emergency department measures, such as the length of time admitted patients wait in the emergency department, or the average number of emergency patients waiting for a hospital bed may reflect that increase.

Another way of understanding the alternate level of care percentage

On September 1, Mary was brought to the emergency department by ambulance because she fell down at home and wasn’t able to get up or walk. After being assessed by an emergency doctor, Mary was admitted to the hospital for surgery on her broken hip. After Mary’s surgery she spent the next two weeks in hospital trying to regain her mobility and independence with daily living tasks. Despite her efforts, it was determined that Mary was not able to manage any of these activities without assistance now or in the near term and it would not be safe to return home, even with home care services. After consultation with Mary and her family, it was agreed that her needs would best be met in a continuing care facility where she would have access to the daily health services and supports she required. Mary was assessed and then approved for a continuing care facility on September 21.

Mary and her family identified their top three preferred facilities for Mary to move in to. On October 15, a room became available for Mary at an appropriate continuing care facility, and she was transported from the hospital to her new home. The time frame used to calculate the alternate level of care percentage is from September 21, when it was decided Mary no longer needed hospital care, to when she left the hospital on October 15. The 25 days Mary spent in the hospital after it was decided she no longer needed hospital care would be combined with the number of days other patients like her spent in the hospital after it was decided they should move to alternate care. The combined total of these days would be converted into a percentage of total hospital bed days during the reporting time period.
Monthly results for November 2019 to March 2020 are not available for the University of Alberta Hospital in Edmonton. Edmonton city results for this time period exclude ALC day data from the University of Alberta Hospital

Alberta Quality Matrix for Health

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess the emergency department’s performance in these dimensions of quality: Accessibility, Appropriateness, and Efficiency.