Consulting Obligations and Collaborative Care Survey

CPSM’s Central Standards Committee (CSC) supervises the practice of medicine of CPSM registrants; this is done through audits, peer reviews and/or multidisciplinary care audits with a focus on education and quality improvement. The CSC wishes to draw your attention to Section 3 of the Standard of Practice for Collaborative Care (the Standard).

Non-Urgent Consultation Requests

This section of the Standard outlines 13 responsibilities for CPSM registrants acting in a consulting role for non-urgent consultation requests (Section 3 - 3.1 to 3.13). The CSC is seeking registrant feedback on Section 3.1 in particular:

Obligations of Consultant Registrant

3.1. A consultant registrant or registrant’s service must respond to the patient and registrant verbally or in writing to a request by a registrant for a non-urgent consultation within 30 days of receipt of the request and must notify the patient and the referring registrant of the anticipated appointment date.

The CSC has identified concerns that the requirement in item 3.1 is not routinely being followed. To better understand why this occurs, if you work in a consulting capacity and are experiencing barriers in your practice (internal or external) that may prevent you from meeting the requirements of item 3.1 in the Standard, the CSC requests your participation in a brief survey.

Note: Diagnostic imaging requests are considered requests for consultation. 

Urgent or Emergent Consultations

The Standard does not currently address urgent or emergent consultations, such as those that may occur between a consultant on-call for hospital service and an emergency department, or between registrants at a rural hospital and a tertiary hospital. This creates inconsistencies in how these situations are dealt with between registrants, resulting in variability in care, and ultimately undermining patient safety.  

The CSC will bring this gap in the Standard and findings from the survey on item 3.1 to CPSM Council in September for further discussion.

If you are a consulting registrant, you are reminded to review all the obligations in Section 3 of the Standard outlined below.

Section 3 of the Standard of Practice for Collaborative Care

3. Obligations of Consultant Registrant

3.1.      A consultant registrant or registrant’s service must respond to the patient and registrant verbally or in writing to a request by a registrant for a non-urgent consultation within 30 days of receipt of the request and must notify the patient and the referring registrant of the anticipated appointment date.

3.2.      If a request for a consultation is declined, the consultant registrant must provide reasons and whenever possible, provide suggestions to the referring registrant for alternative consultants or services.

3.3.      If a consultant registrant agrees to see a patient, the consultant or a designate must contact the patient directly to schedule the appointment (including information such as the date, time, and place, and special instructions) and send a copy of that information to the referring registrant, unless otherwise agreed to by the referring registrant.

3.4.      If a consultant registrant arranges to see a patient without a referral, the consultant must not insist on a request for consultation from the patient’s primary care physician.

3.5.      Except in the circumstance of receipt of consultations through a process whereby a service assigns the patient to a consultant, a registrant who is a consultant must make information available about the process by which referrals are accepted; for example, by telephone, facsimile, secure e-mail or verbally and the registrant should generally be available to respond to requests for consultations.

3.6.      A consultant registrant must, as soon as possible but generally within 30 days of having seen a patient for the first time, report in detail to the referring registrant all pertinent findings and recommendations with respect to a patient seen by the consultant.

3.7.      If the consultant’s conclusions require further investigation or treatment, the consultant must provide an interim report to the referring registrant and a final written report at the conclusion of the consultant’s involvement.  

3.8.      Unless a patient explicitly requests otherwise, a consultant registrant’s report must include, when applicable:

3.8.1. the identity of the consultant;

3.8.2. the identity of the patient;

3.8.3. the identity of the referring registrant and, if different, the identity of the patient’s primary care physician;

3.8.4. the date of the consultation;

3.8.5. the purpose of the referral as understood by the consultant;

3.8.6. information considered, including history, physical findings, and investigations;

3.8.7. diagnostic conclusions; 3.8.8. the treatments initiated, including medications prescribed;

3.8.9. recommendations for follow-up by the referring registrant;

3.8.10.recommendations for continuing care by the consultant;

3.8.11.recommendations for referral to other consultants, but, except in the case of an emergency, such referral must only be made with the approval of the referring registrant;

3.8.12.the advice given to the patient.  

Nothing in this section prohibits a consultant from referring a patient directly to another consultant if it is in the best interests of the patient’s health to do so expeditiously. In the case of a direct referral from one consultant to another, the referring consultant must immediately inform the initial referring registrant of the direct referral.

3.9.      If a patient explicitly requests all or some information not to be disclosed, the consultant registrant must advise the referring registrant that the patient withholds consent for release of information.

3.10.    If the consultant registrant requires further investigation before reaching a definitive diagnosis, the consultant must not delegate arrangement and follow-up of those investigations to the referring registrant without prior agreement with the referring registrant.

3.11.    A consultant registrant must obtain directly from the patient informed consent for any procedure and cannot rely on the referring registrant to obtain the consent.

3.12.    A consultant registrant must explain to the patient the consultant’s role, if any, in the continuing care of the patient and the advisability of follow-up care by the consultant.

3.13.    A consultant registrant must contact the referring registrant at the time the patient is returned to the referring registrant for ongoing care and provide written information as soon as possible thereafter to assist with the patient’s continuity of care.