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Alternate Level of Care (ALC) Designation

Overview and clinical staff and physician tools, supporting ALC designation across Nova Scotia Health.

ALC Overview for Data Entry/Ward Clerks

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The ALC Designation Project includes the following key components:

  • Policy
  • ALC Status Form
  • Standardized definition and criteria
  • Standardized designation and documentation process

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Aim

To standardize the ALC designation process in all acute care settings within Nova Scotia Health.

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Why?

  • Streamlined processes for more accurate and efficient service planning. 
  • Consistent ALC patient documentation and accurate reporting across NSH, facilitating a better understanding of our patient population and patient flow pressures.
  • Improved alignment and collaboration within the interprofessional teams supporting discharge.
  • The ability to identify patients who no longer require acute care, improving patient flow and service planning.
  • The ability to identify supports required to discharge ALC patients, enabling executive leadership to advocate to the government for additional community resources to support the ALC population effectively.

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Definition of Alternate Level of Care (ALC)

Alternate level of care (ALC) is used to identify patients who no longer require inpatient acute care services provided at their current facility. 

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ALC designation is based on meeting all of the following criteria:

  • Clinical status is at baseline or new baseline supported by the patient’s goals of care.
  • Medical issues are at baseline or new baseline with stable treatment plan and care plan established.
  • Mental Health is at baseline or could be managed effectively in community with supports.
  • Medication titration and changes are largely complete or could be managed effectively in community with supports, and discharge scripts could be written if patient was being discharged. 
  • No additional medical diagnosis is being sought or investigated that would require acute care services. 
  • Palliative care treatments, if required could be provided in the community.
  • Nursing assessments are stable. 
  • No test results are pending that could influence the discharge plan (to community or transfer to another hospital).
  • All necessary inpatient physician consults are completed, and arrangements are made for any non-urgent consults to be followed up in the community. 

STAR (Central Zone)

The STAR ADT (Admissions, Discharge, Transfer) system is used to capture all ALC information for patients in Central Zone. Entering this information into STAR in a consistent and timely way makes it possible to track and report on the ALC patient population within Central Zone.

STAR Data Entry Process

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Once a patient has been designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in STAR (on the applicable Admission Revision screen) on the same date as the designation using one of the following processes:

1.1 In STAR where physicians wish to have ALC patients remain on their worklist:

1.1.1 Enter Date of ALC Designation identified on the ALC Status Form.

1.1.2 Enter ALC Support Required identified on the ALC Status Form using the dropdown list.

Ward Clerk Admission Revision screen

Nursing Admission Revision screen

1.2       In STAR where physicians do not wish for ALC patients to remain on their worklist: 

1.2.1    Change the patient’s CUT Code/Service to ALC using the Transfer Patient function, as you would for any CUT Code/Service change for an Inpatient.
1.2.2    Enter Date of ALC Designation identified on the ALC Status Form (Appendix A). 
1.2.3    Enter ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.
1.2.4    The date field will only be changed when a patient is medically discharged or moved back into an acute care status.

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If a patient no longer meets the Nova Scotia Health definition of ALC and all criteria and has been re-designated as acute as per the ALC designation Policy, a data entry clerk/nurse removes the ALC designation in STAR (on the applicable Admission Revision screen) on the same date as the re-designation using one of the following processes:

2.1    In STAR for ALC specific fields:

2.1.1    Remove Date of ALC Designation
2.1.2    Remove ALC Support Required

2.2     In STAR for ALC CUT Codes:

2.2.1    Using the Transfer Patient function, replace the ALC CUT code with the new most appropriate CUT code that reflects the acute care admission.

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If a patient has been re-designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in STAR (on the applicable Admission Revision screen) on the same date as the re-designation using the procedure in Step 1 of the Entering information into STAR once ALC designation has been established section above.

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If the ALC Support Required is changed, a data entry clerk/nurse updates the ALC Support Required (on the applicable Admission Revision screen) using the following process:

4.1    Enter the updated ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.

STAR Instructions and Quick Reference Guide

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ALC-STAR-Initial Designation

Nova Scotia Health, 2024.

ALC-STAR-Removal of ALC Status

Nova Scotia Health, 2024.

ALC-STAR-Redesignation

Nova Scotia Health, 2024.

ALC-STAR-Change of Support Required

Nova Scotia Health, 2024.

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STAR Actions and Frequently Asked Questions

Actions for STAR Data Entry/Ward Clerks

Role Action(s)
Data Entry/Ward Clerks
  • Enter ALC Designation/status change information, identified on the ALC Status Form, into STAR on same day as decision is made.

Frequently Asked Questions

How does the new ALC designation process change the way we work?

The new ALC designation process provides clarity on the classification of ALC patients and recommended supports for discharge from the acute care setting. 
All ALC designation information will be documented on the ALC Status Form. All information on the form must be entered into the appropriate Admission Revision Screen within STAR on the same day the ALC designation/status change takes place. Where physicians do not wish for ALC patients to remain on their worklist, the patient’s CUT code must be changed to ALC using the Transfer Patient function. 

What if a Data Entry/Ward Clerk is not available on my unit to enter ALC Status Change information into STAR?

If a Data Entry/Ward Clerk is not available to enter ALC Designation/status change information into STAR, any care team member with the appropriate systems access may enter the information. 

Units should follow their own internal processes for determining who is responsible for entering admission/transfer information into STAR. Changes in a patient’s ALC status must be communicated to the individual responsible for entering the data into STAR, using the ALC Status Form, in a timely manner after a decision is made.

Where can I find detailed instructions on how to enter ALC information into STAR?

Detailed information on how to enter ALC status information into STAR can be found in the Work Instructions: Tracking of Alternate Level of Care in STAR  document.

Accessing STAR ALC Data/Information

STAR (CZ)

  1. QBR IP NSC EDD- Nursing Station Census Report

  1. QBR IP NSW EDD- Nursing Station Worklist Report

  1. QBR IP PSW EDD- Physician Worklist Report

 

STAR Data Entry/Ward Clerk Factsheet

Integrated Access and Flow Network, 2024

Meditech (Northern, Eastern and Western Zones)

The Meditech ADT (Admissions, Discharge, Transfer) system is used to capture ALC information for patients in Eastern Zone (EZ), Northern Zone (NZ) and Western Zone (WZ). Entering this information into Meditech in a consistent and timely way makes it possible to track and report on the ALC patient populations in these zones.

Meditech Data Entry Process

Click through the tabs for more information.

Once a patient has been designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in Meditech (on the applicable Admission Revision screen) on the same date as the designation using the following process:

1.1    A transfer notice is entered in the Meditech Order Entry module containing the following information: 

1.1.1    Enter Reason for transfer as Change Service.

 

1.1.2    Add Service Type of ALC- Alternate Level of Care. 

 

1.1.3    Enter ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.

 

1.1.4    Enter Date of ALC Designation identified on the ALC Status Form 
(Appendix A). 

1.2    Once the transfer notice is received by Admitting/Access and Flow, a clerk will update the patient’s service in the ADM module.

Click through the tabs for more information.

If a patient no longer meets the Nova Scotia Health definition of ALC and all criteria and has been re-designated as acute as per the ALC designation Policy, a data entry clerk/nurse removes the ALC designation in Meditech using the following process:

2.1    A transfer notice is entered in the Meditech Order Entry module containing the following information:

2.1.1    Enter Reason for transfer as Change Service
2.1.2    Add Service Type as new most appropriate service that reflects the acute care admission. 

2.2    Once the transfer notice is received by Admitting/ Access and Flow, a clerk will update the patient’s service in the ADM module.

Click through the tabs for more information.

If a patient has been re-designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in Meditech using the procedure in Step 1 of the Entering information into Meditech once ALC designation has been established section above.

Click through the tabs for more information.

If the ALC Support Required is changed, a data entry clerk/nurse updates the ALC Support Required using the following process:

4.1    A Change of ALC Support procedure is entered in the Meditech Order Entry module containing the following information:

4.1.1    Enter updated ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.

 

Meditech Instructions and Quick Reference Guide

Click through the tabs for more information.

Click through the tabs for more information.

ALC-Meditech-Initial ALC Designation

Nova Scotia Health, 2024.

ALC-Meditech-Removal of ALC Status

Nova Scotia Health, 2024.

ALC-Meditech-Redesignation

Nova Scotia Health, 2024.

ALC-Meditech-Change of Support Required

Nova Scotia Health, 2024.

Click through the tabs for more information.

Meditech Actions and Frequently Asked Questions

Actions for Meditech Data Entry/Ward Clerks

Role Action(s)
Data Entry/Ward Clerks
  • Enter ALC Designation/status change information identified on the ALC Status Form into Meditech on same day as decision is made.

Frequently Asked Questions

How does the new ALC designation process change the way we work?

The new ALC designation process provides clarity on the classification of ALC patients and recommended supports for discharge from the acute care setting. 

All ALC designation information will be documented on the Nova Scotia Health ALC Status Form. All information on the form must be entered into the Meditech Order Entry module on the same day the ALC designation/status change takes place. 

What if a Data Entry/Ward Clerk is not available on my unit to enter ALC Status Change information into Meditech?

If a Data Entry/Ward Clerk is not available to enter ALC Designation/status change information into Meditech, any care team member with the appropriate systems access may enter the information. 

Units should follow their own internal processes for determining who is responsible for entering Order Entry procedures into Meditech. Changes in a patient’s ALC status must be communicated to the individual responsible for entering the data into Meditech, using the ALC Status Form, in a timely manner after a decision is made.

Where can I find detailed instructions on how to enter ALC information into Meditech?

Detailed information on how to enter ALC status information into Meditech can be found in the Work Instructions: Tracking of Alternate Level of Care in Meditech document.

Accessing Meditech ALC Data/Information

Meditech (EZ, NZ, WZ)

  1. Inpatient Service Report

  1. Census by Nursing Unit

  1. ALC Service Changes

  1. Doctor by Service List

Meditech Data Entry/Ward Clerk Factsheet

Integrated Access and Flow Network, 2024