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Just as physicians are required to admit patients for medical (not social) indications,
Sec 11(2) of the Public Hospitals Act: No physician, registered nurse in the extended class, dentist or midwife shall order the admission of a person to a hospital unless, in the opinion of the physician, registered nurse in the extended class, dentist or midwife, it is clinically necessary that the person be admitted. O. Reg. 216/11, s. 3 (2).
…likewise, when a patient is no longer in need of acute care, it is incumbent on the most responsible physician to discharge the patient. The question at that time should be whether or not the patient meets the standardized definition for ‘Alternate Level of Care’ (ALC):
From the Ministry of Health and Long-Term Care, When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate Level of Care (ALC)1 at that time by the physician or her/his delegate.
If a patient does not meet the requirements of the ALC definition, they should be discharged and removed from hospital. Ethical challenges for staff may include a feeling of abandonment of patients they perceive would either benefit from longer stays, or may be expected to return to the Emergency Department in a matter of days. These are real issues and we do not dismiss them. However, providing care for patients outside of the requirements of consent law and policy governing admission/discharge leads to longer term harms to the system through reduced access. We accept that the healthcare system is overburdened and do not wish to limit in any way the caring and compassion provided by front line staff. But in order to accurately diagnose the real problems in our system, we need to know that the existing policies are being properly utilized. Our concern is that for too long, well-intentioned healthcare providers have essentially masked the problems facing our system.