Alternate Level of Care (ALC)

When inpatients no longer need the intensity of care or level of service provided by their admitting acute care facility, it is important to change their "patient status" to "Alternate Level of Care". The ALC designation effectively "stops the clock" measuring a patient's actual length of stay (LOS). This ensures that facility LOS measures reflect provision of acute care services and not days awaiting transfer to a more appropriate facility.

There are many reasons why a patient's movement to a more appropriate level of care may be delayed or blocked, including:

  • awaiting bed availability in a more appropriate facility, such as those providing dementia supportive living, long-term care, mental health services or rehabilitation; or

  • awaiting community services, such as specific home care interventions or home oxygen, to be readied for a return to a home, group home or assisted living facility.

Managing ALC Status

Determining when an inpatient has completed all interventions appropriate for the current admitting facility can involve a number of considerations. All major medical interventions should be complete, the admitting problem should be resolved or stabilized and co-morbidities should have returned to baseline status (or a new baseline). A clear discharge plan should be documented. Multidisciplinary discharge planning rounds ("Rapid Rounds" in most acute care facilities) facilitate ALC deliberations and decisions.

Once a decision is made to change a patient from acute care to ALC status, a prescriber, transition coordinator or nurse manager can enter an order to initiate ALC. Thereafter, Nursing usually updates the patient's ALC status as details become available about discharge destinations.

  • Prescriber ALC Order: Using the "Orders" activity in a patient chart opened in Hyperspace to an inpatient encounter, enter a "Initiate ALC" order, being sure to select the a level of care from the available pick-list. Usually, prescriber orders will start with "ALC - TBD" as the default selection.

  • Prescriber or Nursing ALC Status Update: Using the "Orders" activity in a patient chart opened in Hyperspace to an inpatient encounter, enter a "Patient Status" order, then use the "Level of Care" pick-list to change the overall ALC status.

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