Episodic Care

Note: a glossary of terms can be found at the end of this document. Glossary terms are indicated in teal with a “^G” throughout this document.

PREAMBLE

All regulated members, including those who provide episodic care^G,  have a professional and ethical obligation to ensure continuity for care to their patients and are expected to use professional judgment in determining how best to accomplish this while acting in good faith to facilitate access to coordinated care.

In accordance with the Continuity of Care standard of practice, regulated members are responsible for the episodic care provided and any follow-up care needed unless another healthcare provider has formally agreed to assume that responsibility. Ultimate responsibility for appropriate continuity of care and follow up of medical care and investigations lies with the ordering regulated member.

Additional information, general advice, and/or best practices can be found in the Episodic Care Advice to the Profession document.

STANDARD

1. A regulated member who requests an investigation, performs a procedure, provides treatment that requires follow-up or makes a referral to another healthcare provider must do so in accordance with the Continuity of Care, Referral Consultation and Transfer of Care standards of practice.
2. A regulated member providing episodic care must:
   1. 1. inform the patient that episodic care is intended to address the patient’s presenting concern(s), referred consultation or identified medical condition(s);
      2. explain the limitations of the episodic medical care they are providing and the extent of any follow-up processes they will manage;
      3. establish whether the patient has a primary care provider and, if so, provide the primary care provider with a record of the encounter if it is in the patient’s best interests^G to do so;
      4. document subclauses (a) through (c) in the patient’s record in accordance with the Patient Record Content standard of practice; and
      5. either provide necessary follow-up care personally or ensure arrangements are in place for follow-up care in accordance with the Continuity of Care standard of practice.
3. A regulated member, including those involved in a team-based care environment, who copies another healthcare provider (e.g., when requesting an investigation, performing a procedure, providing treatment requiring follow-up, making a referral, etc.) must do so in accordance with the Continuity of Care standard of practice.
4. Where another healthcare provider agrees to accept responsibility for follow-up care, the regulated member must document the transfer of care in the patient’s record.
5. A regulated member must provide or arrange for continuous after-hours care in accordance with the Continuity of Care standard of practice.

GLOSSARY

Episodic care:  refers to a single encounter with a patient focused on a presenting concern(s), identified medical condition(s) or referred consultation, where neither the regulated member nor patient have the expectation of an ongoing care relationship, in accordance with the Establishing the Physician-Patient Relationship standard of practice.

Patient’s best interests: will differ from patient to patient and will depend on the regulated member’s clinical judgment, but the default expectation is to provide the patient’s primary care provider with the record of the encounter to ensure they have the information necessary to ensure continuity of care for their patient. When a record of the encounter is not shared with the primary care provider, the member should thoroughly document the rationale behind their decision to withhold the information in the patient’s record.

ACKNOWLEDGEMENTS

CPSA acknowledges the assistance of the College of Physicians and Surgeons of British Columbia, the College of Physicians and Surgeons of Manitoba, the College of Physicians and Surgeons of Nova Scotia, the College of Physicians and Surgeons of Ontario, the College of Physicians and Surgeons of Prince Edward Island, and the College of Physicians and Surgeons of Saskatchewan in preparing this document.