The Project

Alternate level of care (ALC) in hospitals is a complex, systemic, recurring, and costly issue that has become a top priority for the Quebec Minister of Health and Social Services and of healthcare institutions.

According to the daily report situation in emergency departments and hospitals (Daily Statement of the Emergency Situation in the Hospital Center (DSESHC)), the definition of a person classified with ALC status is as follows: “An inpatient is considered to be in ALC status if his or her condition still requires care and services, but it is no longer necessary, in terms of specificity or intensity, for them to be provided in the acute care beds of the general and specialized hospital center. The user is considered to require an alternate level of care (or ALC user) from the moment the healthcare team determines that the acute care unit is no longer the most appropriate environment to provide the level of care required by their condition, until their departure.”

ALC users are characterized by a prolonged occupation of short-term beds when their medical condition no longer requires it. This inappropriate use of beds creates an accessibility challenge for other users whose health condition requires hospitalization.

Hospital fluidity is therefore based on a complementary and collaborative synergy that must be established between upstream hospital services, the emergency department, care units and services offered after hospitalization. In an organizational context, this fluidity implies services that are found in all clinical directions and in multiple service delivery locations.
The rate of ALC is one of the required indicators required to measure the health of the hospital’s fluidity. A high ALC rate in acute care beds would indicate barriers to fluidity, while a lower rate reflects an optimal, integrated and established management.

Reasons for action

In 2019-2020, faced with an ALC rate approaching 20%, and confronted with numerous organizational obstacles, the Integrated health and social services centres of Montérégie-West decided to undertake a vast process review and initiate digital transformation with the objective of improving the fluidity of user trajectory in ALC status.
Obstacles identified became levers that the organization mobilized their collective efforts.

The main barriers identified were:

• Multiple tools required to manage ALCs
• Complex communication
• Lack of understanding of the ALC function within the organization
• Access to information is non-comprehensive with the impossibility for real-time data
• The search for culprits > the search for solutions
• The 2020 healthcare emergency required a significant increase in hospital capacity

Simple, concrete and effective solutions

Founded on best practices, the solutions selected had to:

• Establish mechanisms for collaboration and contextualized communication
• Track and analyze users with an ALC status on a daily basis
• Respect timeframes for obtaining confirmation of referral to targeted resources
• Involve all stakeholders required to contribute to the effort
• Implement tools to ensure continuity of information
• Develop dashboards and monitor indicators on a daily basis in real-time

The development of a clinical-administrative solution has proven to be a central component of the Integrated health and social services centres of Montérégie-West approach. The IT solution provides caregivers the opportunity to monitor fluctuations in ALC rates in real-time and ensures that users receive optimal care that takes their health needs into account. It supports team mobilization in the implementation of all that is necessary to ensure that the user is in the right place at the right time.

The solution also made it possible to strengthen the collaborative work between stakeholders involved in the trajectory of the ALC user, demonstrating the added value for both users and staff.

Upon completion of this vast project, the following solutions were implemented making it possible to achieve their main objective – to reduce the rate of users in ALC status:

• Simplification of the referral process for ALC users
• Implementation of daily meetings to manage ALC users
• Major digital transformation through the development of a clinical-administrative solution (OCTOPUS- ALC) to support the clinical activities of healthcare workers involved in the daily follow-up of users and clinical-administrative activities of managers
• Sharing a common vision of the ALC function throughout the organization
• Follow-up of ALC users in real-time and users at risk of becoming ALCs
• Support for daily ALC fluidity meetings
• Contextualized communication between the various stakeholders
• Monitoring of indicators and statistics in real-time
• Production of departmental reports using the solution
• Elimination of parallel data compilation systems (elimination of double and triple data entries)

Highlights

• Fully developed solution within 2 months (January to February 2021)
• Nearly 140 users
• Solution accessible on all platforms
• Reserved space for documentation within the solution
• A gain in 48 short-term beds and the time of 4 full-time employees
• Average NSA rate reduced from 20% to 8%

An Essential Partner

This digital transformation was made possible thanks to the essential contribution of our partner, Octopus.

With the goal of modernizing the health and social services network through innovative pre-configured solutions backed by best practices, Octopus provides real-time information, delivering added value to healthcare professionals and managers.

Having participated in many projects since 2005, Octopus discovered that there was a lack of user-friendly, easy-to-use optimal tools that met the needs of the clinical-administrative function. It’s why they developed Octopus MD with the goal of improving the efficiency of care and the quality of services delivered to users.

Source : Le Point en santé et services sociaux, volume 16, numéro 3, édition hiver 2022