Context: An inpatient is considered "medically ready for discharge" (MRD) when the primary provider discipline ("medical") for an inpatient encounter has completed its acute clinical tasks and the patient is dischargeable from a "medical" perspective. Once a patient is medically ready for discharge, consideration should be given to shifting the patient's level of care from "Acute" to an "Alternate Level of Care" (ALC). The ALC status is assigned when a medically ready patient remains in hospital because they are waiting for a different setting or service (e.g., home care, rehabilitation, continuing care bed) to become available.
Answer: MRD and ALC are two related but distinct concepts that impact discharge planning. MRD is a clinical determination and therefore a prescriber responsibility and priority, determined when the primary provider discipline ("medical") for an inpatient encounter has completed clinical tasks associated with the reason for admission. ALC, on the other hand, is more of a hospital administrative designation, and can be actioned by members of the broader multidisciplinary care team, including prescribers, nurse managers, or transition coordinators. Patients may remain in an MRD state for a (short) time before discharge or before an ALC determination is made.