Are you up to standard? Referral Consultations

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Do you refer your patients to consulting healthcare providers? Do you provide consultation services within your practice? If your answer is yes to either of these questions, then the Referral Consultation standard of practice applies to you.

Every patient living in Alberta has a different healthcare journey. For many of them, conditions may develop or evolve over time and require the help of multiple practitioners with varying backgrounds. Across specialties and disciplines, successful teamwork greatly impacts positive outcomes for patients. Referring and consulting practitioners must work together to communicate clearly, quickly and cooperatively in order to support high-quality, successful care for their patients. Misunderstandings regarding roles and responsibilities or poor information exchange present significant risk to patients, especially when relating to diagnostic information or urgent care situations.

Referring a patient

Part of providing excellent care is knowing your limitations. Every CPSA regulated member must be able to recognize cases where collaboration with another practitioner is necessary to adequately address a patient’s needs. It is imperative for patients to be active participants in their care journeys. Referring a patient for consultation includes discussing the decision with your patient and confirming agreement. In some cases, a patient may not agree with your decision, and the difference of opinion must be documented within the patient record, along with the accompanying health implications.

At times, a patient may request that you refer them to another provider. In these cases, when requests are reasonable (such as for a second opinion or for services outside of your scope), you must respect the patient’s request. That being said, if you determine that the request does not have a clinical benefit, you are entitled to refuse it. Again, it is important to document the request and your rationale for refusal to refer for consultation. Following disagreement, you must continue providing medical care within your scope and in the best interest of the patient. A notable exception would be if the relationship has broken down significantly, making it irrecoverable. Then, ending the doctor-patient relationship may occur in accordance with the Terminating the Physician-Patient Relationship standard of practice.

When referring a patient for consultation, you must have conducted related investigations to conclude a referral is needed, engage in discussions with the patient about fees that may not be covered by the Alberta Health Care Insurance Plan (if applicable), and finally, make a timely written request for consultation.

Referring to emergency or urgent care

If referring a patient for an urgent and/or emergent consultation, you must contact the consultant or emergency service directly (e.g., calling Referral, Access, Advice, Placement, Information, & Destination (RAAPID)) to discuss the referral and pertinent clinical information, including providing relevant documentation when possible.

If it’s not possible to call ahead (e.g., there are multiple hospitals the patient could attend), a letter should be sent with the patient outlining the information necessary to provide the care needed.

Providing and accepting consultations

If receiving consultation requests and referrals is part of your practice, you must make yourself reasonably available to respond to referring physicians, making sure they know the process for submitting requests for consultation. Once a request is sent your way, you must acknowledge receipt within 7 days and provide your decision to accept or deny the request within 14 days.

If you accept a request, you must contact the patient no later than 14 days after request receipt (sooner if the urgency of the situation demands it) to work towards scheduling an appointment, making sure to inform them of any out-of-pocket fees (if applicable). Within 30 days of seeing the patient, you must provide a written report detailing the appointment and findings directly to the referring provider. If you deny a request, you must provide the referring provider with your reason for denial and provide alternative suggestions to ensure the patient’s care is not disrupted.

Questions? Review the full Referral Consultation standard of practice for more details on each requirement and/or read the accompanying Advice to the Profession document for additional guidance and clarity. For other inquiries, feel free to reach out to support@cpsa.ca for assistance.