Receiving and Discharging Patients to and from Emergency Departments & Urgent Care

This is Part 2 of guidance to the profession on collaborative care regarding the referral of patients to emergency or urgent care. Read Part 1 - Referring Patients to Emergency Departments & Urgent Care.

In Part 1, we outlined the expectations of referring physicians when transferring a patient to an emergency department or urgent care. Equally as important are the expectations for physicians who are asked to accept patients.

Decisions to refer patients to the ER or urgent care should never be taken lightly. By the time a referral is made, patients have already undergone clinical assessment and management, and physicians receiving these referrals are not to downplay or dismiss the referral.

Receiving Responsibilities

The purpose of a referring physician phoning the emergency or urgent care physician is to relay relevant information about the patient and confirm their acceptance of care.

It has come to CPSM’s attention that some ER and urgent care physicians have offered patient management advice and refused to accept patients upon receiving these calls. These actions jeopardize patient safety; we have seen the detrimental consequences of turning patients away from the ER and urgent care.

When it is not safe to accept the transfer of a patient

CPSM acknowledges that ER and urgent care wait times may factor into this issue; however, wait times alone should not prevent patients who may require hospital care from being transferred to emergency or urgent care settings. The safety and well-being of patients should take precedence.   

Discharging Responsibilities

At the time of discharge, the emergency department or urgent care physician responsible for the care of a patient must adequately communicate with other care providers; this is especially crucial when timely follow-up is required.

Communication can be accomplished through eChart, however, be mindful that not all providers have timely access to eChart.

Discharge communication can include:

• Sending the patient home with clinical findings, care documents, and/or follow-up instructions.
• Arranging follow-up care with the patient’s primary care physician (e.g., when tests that require follow-up are ordered).
• Referring the patient to a consulting physician or a specialist to transfer necessary medical information.

All physicians share the responsibility of delivering coordinated and comprehensive care to patients.

Recognizing that there are current challenges in the system, CPSM is reviewing the Collaborative Care Standard to update it to reflect current realities. 

Until then, Section 5 on Collaborative Care in the CPSM Standards of Practice Regulation includes the following professional obligations:

When a member and one or more other health care providers are involved in the health care of a patient, the member must

 (a) collaborate with other health care providers in the care of the patient and in the functioning and improvement of that health care;

(b) treat other health care providers with respect;

(c) recognize the skills, knowledge, competencies and roles of others involved in the patient's care;

(d) understand the member's role and the role of other health care providers involved in the health care of the patient;

(e) identify himself or herself to the patient or his or her representative and explain the member's role and responsibility;

(f) communicate effectively and appropriately with the other health care providers; and

(g) document, on the patient record, the member's contribution to the patient's care.