Archive Performance Materials: Emergency Room (ER) and Alternate Level of Care (ALC)

The LHIN works closely with the Emergency Services Steering Committee (ESSC), the ALC Steering Committee, hospitals, long-term care, Community Care Access Centre (CCAC) and the community support services sector to develop and implement targeted strategies to improve access to care.

Performance for ER and ALC includes: ER ALC thumbnail

  • 90th Percentile ER Length of Stay for Admitted Patients
  • 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III*) Patients
  • 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V*) Patients
  • Percentage of ALC Days

ER Performance Report Cards

ALC Performance Report Cards


ER Length of Stay (LOS)

  • Data on the LOS people spend in the ER is for information purposes only. Individuals who need to go to the emergency should not delay in going because of a LOS reported by a hospital.
  • The LOS shown indicate the entire length of time individuals spend in the ER, from the time they arrive to the time they leave or are admitted. During this time people receive the health care they need.
  • The LOS an individual experiences in the ER is affected by a number of factors such as: the number of people coming to the ER, the severity of the individual’s illness, the type of diagnostic tests required, whether the person needs to see a specialist, and the time of day.
  • Individuals coming to the ER will be assessed for how acute (serious) their health issue is (triage). Individuals with critical (life threatening) or urgent health needs will be treated before those with minor or less-urgent needs.
  • Individuals who come to the ER and need to be admitted may experience a long LOS in the ER until a bed becomes available. A hospital’s bed capacity is impacted by the number of people coming through the ER that need to be admitted, the number of people in the hospital that are not ready to be discharged and the number of people waiting in a hospital bed for an alternate level of care (ALC). During this time people receive the health care they need.
  • For less urgent needs, there are alternatives to ERs, including the family doctor or Family Health Team, after-hours clinics, and Urgent Care Centres. Learn about these and other health care options in Understanding Your Health Care Options.

Percentage of ALC Days

  • Percentage of ALC Days is a measure of the number of days a person waits in a hospital bed after his/her physician (or designate) has determined that their acute treatment is complete and they are ready to move to another care setting. It is not a measure of the number of beds occupied by individuals waiting for an alternate level of care.
  • When a patient moves to an alternate level of care, the percent ALC days are calculated and applied to the date the person is discharged. This means that if a patient has been waiting three years for a destination, all three years (1,095 ALC Days) are reported on the day of discharge and applied to that month’s reporting period.
  • The LHIN’s Percentage of ALC Days metric fluctuates as hospitals work with the HNHB CCAC to help discharge patients who have experienced long waits in hospital. As the ALC days are counted at discharge, the ALC metric will increase.
  • There are many different destinations patients designated ALC could be waiting for, such as: complex care, convalescent care, rehabilitation, acute or specialized mental health bed, supervised or assisted living, home, long-term care (LTC), and palliative care.
  • Patients that choose to wait longer for a destination, such as a particular long-term care home (LTCH) with a long wait list as opposed to choosing a LTCH that could provide that level of care sooner or go home to wait with CCAC services, will experience long waits in hospital.

*The Canadian Triage and Acuity Scale (CTAS) is a 5-point scale that ERs use to evaluate a patient’s acuity level to more accurately define the patient’s needs and allow for timely care:

  • CTAS I requires resuscitation. It includes conditions that are threats to life or imminent risk of deterioration, requiring immediate aggressive interventions (e.g., cardiac arrest, major trauma or shock states).
  • CTAS II requires emergent care. It includes conditions that are a potential threat to life or limb function requiring rapid medical intervention or delegated acts (e.g., head injury, chest pain, gastrointestinal bleeding, abdominal pain with visceral symptoms, or neonates with hyperbilirubinemia).
  • CTAS III requires urgent care. It includes conditions that could potentially progress to a serious problem requiring emergency intervention (e.g., mild moderate asthma or dyspnea, moderate trauma, or vomiting and diarrhea in patients younger than 2 years).
  • CTAS IV requires less urgent care. It includes conditions related to patient age, distress, or potential for deterioration or complications that would benefit from intervention or reassurance within 1 to 2 hours (e.g., such as urinary symptoms, mild abdominal pain, or earache).
  • CTAS V requires non-urgent care. It includes conditions in which investigations or interventions could be delayed or referred to other areas of the hospital or health care system (e.g., a sore throat, menses, conditions related to chronic problems, or psychiatric complaints with no suicidal ideation or attempts).