POLICY:
WALK-IN CLINICS AND EPISODIC CARE
PREAMBLE
The
College of Physicians and Surgeons of Saskatchewan (CPSS) has responsibility to
set standards and policies that result in high quality care for patients
regardless of their point of contact with physicians in the health care system.
For reasons of convenience or ease of access, patients often turn to episodic
services such as walk-in or “no-appointment” physician visits in clinics.
Physicians are expected to manage these episodic encounters to provide optimal
continuity of care.
An
excerpt from the Canadian Medical Association and CPSS Code of Ethics provides
the basis for this policy.
Responsibilities to the Patient
19. Having accepted professional
responsibility for a patient, continue to provide services until they are no
longer required or wanted; until another suitable physician has assumed
responsibility for the patient; or until the patient has been given reasonable
notice that you intend to terminate the relationship.
This
policy is intended to apply to episodic care provided in medical practices,
such as, but not limited to:
1. Walk-in clinics.
2. Appointment-based family
practice clinics.
3. Primary health care clinics.
4.
Minor emergency clinics.
POLICY
1. Personal Family Physicians –
When being registered at a clinic, patients must be asked if they have a family
physician who they usually see for care and, if so, the name of that family
physician must be recorded on the patient’s record.
a) Patients who have a family
physician must be advised that information about the current visit will be sent
to their family physician and given the option to request that this not be
done. Written documentation of such a request must be obtained in each and
every case.
b) Patients who
do not have a family physician must be encouraged to establish a patient/doctor
relationship with a family physician. Suggestions should be made to patients
about the value of such a continuing care arrangement. The establishment of
such a care arrangement should be facilitated if possible, either within the
clinic or with another physician or clinic.
2. Patient
Records – Physicians must document each patient visit in accordance with
accepted standards of care and guidelines for medical record-keeping.
Acceptable documentation includes an accurate and complete account of each
patient visit including information such as related history, assessment,
treatment, investigations, and follow-up. Suitable administrative systems must
be in place to send information about the visit to the patient’s family
physician or primary care clinic, if the patient has one.
3. Prescribing
– It is advisable for physicians to use PIP (Pharmaceutical Information
Program), particularly when dealing with patients who require prescriptions for
controlled substances.
4. Test
Results Management – Physicians ordering investigations must communicate the
results to the patient and undertake any appropriate follow up, or be satisfied
that there is a system in place to provide this communication and follow up.
5. Referrals –
When a patient is deemed to require the attention of a specialist consultant:
a) if the
patient has a family physician
i. non-urgent consultations should be recommended to and
arranged through the patient’s family physician,
ii. urgent
consultations should be arranged, and the physician initiating the consultation
should clearly advise the consultant if the patient has a family physician so
the consultant will keep that family physician informed and involved in the
patient’s ongoing care.
b) if the patient does not have a
family physician, consultations shall be arranged and appropriate follow up
undertaken.
6. Chronic
Disease Management – Patients who require ongoing care for chronic diseases
should be advised of the inability for episodic care services to adequately
meet their needs, and should be strongly encouraged to establish a
patient/doctor relationship with a family physician.
7. Imaging
and Laboratory Services – Physicians who own and operate a diagnostic
imaging unit or laboratory services within their clinic shall adhere to the
Council’s policy with regard to radiological supervision of diagnostic imaging
units and other related standards of good practice.
8. Multi-Physician
Clinics – In clinics where more than one physician practices, a managing
physician shall be designated to:
a) be responsible for implementing appropriate arrangements
to handle follow up of test results by other physicians, follow up of test
results after hours, and handling of urgent cases, and
b) develop and
implement a policy manual which gives clear direction to the physicians
employed in the clinic with regard to the policies and standards they shall
observe while practicing in that clinic.
References
CPSBC – Walk-In Clinics – Standard of Care, Primary Care
Multi-Physician Clinics
CPSA – Episodic Care Standard of Practice 15
CMA – Code of Ethics
CMPA – Responsibility for Follow Up of Investigation, June
2008 IL08020-1-E
Guideline Adopted by Council, June 2012
To be Reviewed June 2017