Background:  Stroke is the leading cause of adult disability in Canada.  11% of patients are left with severe disability that prevents them from returning to their previous living environment and requiring transfer to a long term care (LTC) or complex continuing care (CC). Delays in admission to LTC or CC results in patients who require an alternate level of care (ALC) occupying beds on the acute stroke unit. In FY 2016 – 2017, the Regional Stroke Centre acute stroke unit had a proportion of ALC days to acute days of 29.7% and 8.5 ALC patient bed equivalents. There was no standardized discharge planning process for ALC patients.

Purpose: To streamline the ALC processes to achieve a 10% reduction from baseline by September 2017 in the: 1) proportion of ALC days to acute days; 2) number of ALC days and 3) number of ALC patient beds days. 

Methods: A process map of the patient journey from admission to discharge for the three commonly used ALC pathways was completed. Pre/post staff knowledge of and satisfaction with the ALC processes were undertaken. Pre/post patient and family feedback was sought via experience based design.

Results: Standardized processes, communication tools and consistent management were implemented. This resulted in a decrease of the: 1) proportion of ALC days from 29.7% to 25.1%;2) number of ALC days from 2825 to 1952 and 3) ALC bed equivalents 8.5 to 6.1. 

Conclusions: Utilizing lean methodology led to standardization of the ALC discharge planning process that significantly reduced the ALC rates on the unit.

Utilizing Lean Methodology to Streamline the Alternate Level of Care Discharge Planning Process  Within the Integrated Stroke Program of a Regional Stroke Centre