How Clinical Ethics Consultants Navigate Complex Acute Care Discharge Cases in Ontario

Abstract

In Ontario, discharge planning is an overarching term referring to patient transitions through the healthcare system. Discharge planning encompasses the continuum of care from primary to acute care to post-acute care in the community or an institutional care setting. Due to its impact on related issues such as emergency department wait times, patient flow through the healthcare system has been an area of emphasis. Patients that are in acute care and awaiting discharge to another institutional setting such as a Long Term Care Home are designated as Alternate Level of Care (ALC). Because ALC patients could be receiving the level of care that meets their needs in another setting, this is considered an inefficient use of healthcare resources, and by extension thereby poses resource allocation concerns.

In the authors’ experience, clinical ethics consultants are routinely consulted to assist with complex discharge planning cases. While the comprehensive range of ethical issues associated with discharge planning may vary based on the facts of the particular case there are four broad domains of issues that pertain to most acute care discharge planning in Ontario and include: (1) Resource allocation of finite healthcare resources (2) Supporting patient/substitute decision making (3) Moral distress and (4) Procedural fairness. An illustrative case is used to further draw on the four identified domains of issues and demonstrate the practical contributions of clinical ethics consultants to address complex discharge planning cases.