ALC data informs decision-making

ALC data informs decision-making - PHOTO BY: Photo courtesy of Lindsay Smylie Smith

North Bay Regional Health Centre IT team developed solution for transmitting real time ALC data to Cancer Care Ontario.

Having accurate and timely data on the number of alternate level of care (ALC) patients taking up acute care beds is a prerequisite for understanding the severity of the problem and developing strategies to alleviate it.

Hospitals are required by the Ministry of Health and Long-Term Care to submit ALC and a wide range of other wait-time data to Cancer Care Ontario’s Access to Care Informatics Unit in a prescribed format, but have to figure out how to do it on their own.

The North Bay Regional Health Centre’s IT staff came up with a particularly elegant solution. Working in concert with its hospital information system provider, Meditech, IT staff at North Bay Regional developed a real-time interface from the hospital information system to Cancer Care Ontario.

Data relating to the identification and discharge of ALC patients was already being captured by Meditech, but just sat there. Now, “as soon as an order is filed in the system, a message is created and that message goes through an interface directly into the wait-time information system,” explained Lori Mayne, the hospital’s wait-time information co-ordinator. No extra work is required by front-line health-care workers or IT staff.

Prior to the development of the interface, the hospital submitted manual statistical reports to the Ministry, the North East LHIN and the Ontario Hospital Association.

The Ministry of Health gave Cancer Care Ontario’s Access to Care Informatics Unit the task of compiling ALC statistics to ensure “apples to apples comparisons” between hospitals, said Mayne.

“Before, we would report the numbers, but without a consistent set of specifications, hospitals would report differently and decisions were being made that were questionable, whereas now it’s standardized and consistent.”

The data showed, for example, that on November 2, there were 98 ALC patients occupying beds at North Bay Regional, including 63 patients in the district hospital and 35 in the regional mental health centre. That accounted for 21 per cent of acute care and mental health beds, a dramatic improvement over the 38 per cent reported in the previous fiscal year. The hospital’s target is 17 per cent.

The number of ALC patients at North Bay Regional would be significantly higher if not for the administration’s successful application for rehabilitation and complex continuing care beds in planning for the new hospital, which opened in January 2011.

“We saw this tidal wave coming,” said Nancy Jacko, vice-president, clinical integration and chief nursing executive.

The hospital received approval for 42 complex continuing care beds and 29 rehab beds, taking some pressure off the ALC predicament.

The rehab and complex continuing care units were designed for their intended use with kitchen and dining areas to help patients acclimatize to daily routines in their own home.

The high number of ALC patients at North Bay Regional is attributable to the unique circumstances of the hospital and the health-care services available in the city.

Unlike Sudbury and Sault Ste. Marie, said Jacko, North Bay doesn’t have a hospice, so palliative care patients add to the hospital’s ALC numbers. Similarly, patients with dementia and behavioural issues in the hospital’s mental health centre take up beds at North Bay Regional because long-term care facilities are not equipped to care for them. Also accounting for North Bay’s high ALC numbers is North Bay’s decision to keep all of its patients under one roof, in contrast to both Sudbury and Sault Ste. Marie hospitals, which are temporarily housing patients at former hospital sites.

ALC numbers in North Bay could come down further if the hospital is successful in applying for a number of assess-and-restore beds to serve elderly patients who need a little extra time to recover from surgery

The data collected on the hospital’s ALC status is a big help for decision-making, said Jacko. “I can go in and see that we had 64 new ALC patients in the month, and that we discharged 61. That gives you an idea of the flow.”

Jacko can also see at a glance where patients were discharged to and what their special needs are.

“The information is very useful,” she said. “We were capturing ALC data before, but we wouldn’t know how long a patient was ALC or what their special needs are.”

At the same time, the data is available to address the larger ALC issue, compare hospitals and inform public policy.

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