Brock research explores factors keeping long-term ‘alternate level of care’ patients in hospital

It’s a scene repeated all too frequently: a patient remains in hospital long after they’ve been successfully treated because there’s nowhere for them to go where they’ll be safe and cared for.

Quinten Carfagnini wanted to know who undergoes this experience and why.

Through a collaboration between Brock University’s Goodman School of Business, the Faculty of Applied Health Sciences and Niagara Health, Carfagnini conducted research on the factors keeping non-acute patients in hospital for more than 30 days.

“These patients are done with their care, but they’re stuck in the bed that they’re in, which is obviously unfortunate because those who do require treatment need to be able to get into that bed,” says the Health Sciences PhD student.

Carfagnini and his team collected information from the Ontario Wait Time Information System (WTIS) database on more than 16,000 alternate level of care (ALC) patients who received care in Niagara Health hospitals from September 2014 to September 2019.

ALC patients are defined as being those “who occupy a bed but do not require the intensity of services provided in that care setting.”

Carfagnini and his team’s research, published at the end of March, found long-stay ALC patients were more likely to be:

  • male
  • destined for long-term care facilities and supervised or assisted living rather than being sent home
  • requiring specialized bariatric equipment such as lifts, custom doors and heavily braced ceilings
  • requiring specialized feeding services, such as the use of gastric tubes or IVs
  • patients who had expressed physically or verbally disruptive behaviours and may require supports designed to help them with challenging behaviours
  • requiring isolation, in some cases, because they have a specific infection, such as methicillin-resistant staphylococcus aureus

“The longest wait times were for those trying to be discharged to long-term care facilities, which previous research has shown,” says Carfagnini. “Our study looked at more personalized patient requirements, such as bariatric or psychological needs that they may require at their discharge destination.”

Elaina Orlando, Research Manager at Niagara Health (NH) and Adjunct Professor in Brock’s Department of Health Sciences, says the backlog of ALC patients is a “complex problem” involving many stakeholders in health-care systems that are stretched for resources.

“Quinten’s research has given us a different lens on our particular population experiencing this situation,” she says. “We have this clearer picture of who is in our hospital system and in our beds, and that gives us new ways to think about potential solutions within our control to change as an organization.”

Professor of Epidemiology Brent Faught, Carfagnini’s supervisor, notes how the research follows legislation passed last year by the Ontario government. Bill 7, More Beds, Better Care Act, 2022 empowers hospitals to transfer ALC patients to a long-term care home that the hospital sources. Patients face a $400 per day fine if they refuse to leave the hospital.

He says the research partnership enables Niagara Health and Brock to come up with local measures that address the province-wide problem of a shortage of hospital beds.

“This research and partnership give us a stronger voice in terms of what is actually happening within our own community,” says Faught.

This Brock-NH partnership is one of the community-engaged research projects to come out of the Goodman School of Business’s Centre for Business Analytics (CBA). The CBA also created a service-learning initiative that connects students and faculty with external partners, including Niagara Health.

Carfagnini, who also did his Master of Science under Faught’s supervision, had access to data and personnel at NH during his studies. Faught and Associate Professor of Health Sciences Madelyn Law collaborated with CBA’s founding director Anteneh Ayanso on how to further this Niagara Health research.

Ayanso says he and the team “knew immediately the big opportunity” there was to uncover trends in the “massive” datasets that would help health-care professionals deal with challenges around long-term hospital stays.

“A partnership like this is so exciting because you hear directly from the people who work with the problem,” says the Professor of Information Systems. He says students such as Carfagnini are able to experience how data analytics theories in the literature make an impact in real life situations.

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