Emergency Department and Alternate Level of Care 

Central LHIN funds six public hospitals (Humber River Hospital, Mackenzie Health, Markham Stouffville Hospital, North York General Hospital, Southlake Regional Health Centre and Stevenson Memorial Hospital). .

Collectively, these six public hospitals operated 2,227 beds for acute care, complex continuing care, rehabilitation and mental health with over 685,000 total days (acute and ALC) in 2017/18.

 

Alternate Level of Care (ALC)



When patients no longer need acute care in hospitals, they often remain in acute care beds while waiting to be discharged or transferred. They need an alternate level of care such as an appropriate community care setting or home care.

The percentage of ALC Days in Central LHIN increased 1.9%, from 14% to 15.9% from 2013/14 to 2016/17. 

Additionally, Central LHIN hospitals supported 635,000 emergency department (ED) visits in 2017/18, an increase of 15.8% from 2013/14, compared to the provincial average of 8.8% over this same timeframe. As well, Central LHIN EDs see a greater number of higher acuity patients, with 25.1% of local patients scoring 1 and 2 on the Canadian Triage Acuity Scale compared to the provincial average of 20.5% (2016/17 data).

Initiatives Underway

Supporting system capacity and patient experience by reducing emergency department (ED) wait times and decreasing the time that people spend in hospital beds waiting for alternate levels of care (ALC) is a priority in the Central LHIN. Some of the initiatives underway in the Central LHIN to either reduce ED wait times or ALC rates included:

  • Operated the Central LHIN ALC Collaborative for cross-collaboration between hospitals, home and community care, and community support organizations to identify gaps and opportunities to enhance care transitions and patient flow. Based on outcomes from the ALC Leading Practices Self-Assessment, several ALC avoidance strategies were implemented.

  • Opened Reactivation Care Centre (RCC-Finch), a Central LHIN Hospitals Collaborative in December 2017. RCC-Finch involved re-development of a former hospital site to add 148 new hospital beds to improve patient flow and support access to an enhanced level of reactivation care for ALC patients from several local hospital. An additional 58 temporary complex continuing care and rehabilitation beds from Mackenzie Health (Richmond Hill) were added to this site until the new Mackenzie Vaughan Hospital opens in 2020/21.

  • Opened Reactivation Care Centre (RCC-Church) in December 2018. Phase One included 90 beds across three units, with Phase Two slated to open in May 2019 with 124 beds across four units. This site replicates the model of care implemented at RCC-Finch.

  • Funded the Behavioural Support Transition Resource program in hospitals, including the RCC. This program, operated by LOFT Community Services, offers dedicated in-hospital resources to support early identification and stabilization of patients with responsive and cognitive behaviours, and support their transition to the most appropriate discharge destinations.

  • Supported the development, implementation and spread of iPlan to five hospitals, which is a web-based, electronic discharge planning dashboard through the Central LHIN ALC Collaborative. This tool captures the journey of identified high-risk patients, provides real-time situational awareness, and aligns with a standardized discharge planning pathway, which promotes proactive discharge planning within Central LHIN hospitals.

  • Supported frail, at-risk seniors through Assess and Restore programs which help patients maintain or regain functional independence, transition to home, and remain in the community for as long as possible.

  • Implemented Hospital to Home, a cross-sector model of care between Central LHIN Home and Community Care, Markham Stouffville Hospital, and York Region Paramedic Services. This program helps discharged patients better manage chronic diseases in their own homes with the support of an inter-disciplinary team comprised of hospital, home care and community partners.

  • Implemented Transitional Care at Home program, a hospital discharge option to offer resources to patients, including enhanced activation and restorative care services in the home setting to allow the patient to remain in the community for as long as possible before transition to an alternate discharge destination (e.g., retirement home or long-term care home).

  • Instituted a new streamlined intake process between Central LHIN and Toronto Central LHIN for Humber River Hospital or Sunnybrook Hospital patients transitioning home. Either LHIN completes service ordering for the patient prior to discharge to support a more seamless transfer, better patient experience and timely initiation of service.

  • Achieved 100% contribution from all six Central LHIN hospitals to Connecting Ontario, which is a provincial Electronic Health Record to share select data across hospital information systems, Central LHIN home and community care, laboratory information systems, diagnostic imaging and drug information.

  • Implemented eNotification with two hospitals (Markham Stouffville Hospital and North York General Hospital) to automatically notify primary care providers and the Central LHIN when a home and community care patient is admitted to or discharged from hospital (ED or in-patient).