Analysis: CPSM Collaborative Care Standard
As announced last week, the College of Physicians and Surgeons of Manitoba (CPSM) is calling for feedback from physicians and patients across the province on a proposed new Standard for Collaborative Care aimed at supporting clearer and more respectful communication between doctors as they collaborate on patient care.
A multi-disciplinary working group, including specialists, family physicians, and public representatives, spent more than two years updating the Standards.
Collaborative Care starts when a physician and second provider begin to work together in the care of a patient and ends when the second provider’s help is no longer needed. This includes, for example, referrals, consultations, eConsults, discharges, transfers, and on-call support.
Doctors Manitoba is providing further details on the changes you’ll see in the draft standard as well as our analysis. We encourage physicians to review the new standards carefully, and to share any responses you send to CPSM with us to help inform our response on behalf of the profession.
Our Take
We know referrals and consultations are a top frustration and administrative burden for both referring and consulting physicians in Manitoba. Some of the requirements in the proposed standards may feel new to some, but in many cases they reinforce or clarify requirements that already exist. It’s important to review the new standard and consider your current practice to understand how the changes will impact you.
Overall, the new standards appear to respond to concerns we’ve heard from physicians. Interactions should be based on collegial respect and ensure there is clarity in role and responsibility when collaborating on patient care.
- Referring physicians should be clear in their request and include all necessary details to avoid misdirected referrals or incomplete information.
- Consultant physicians should be timely with their responses and support continued patient care and treatment.
While the new standards respond to some of the concerns we’ve heard, it’s important to acknowledge that CPSM cannot fix the gaps and inefficiencies in the health system which too often impair physicians’ abilities to follow the aspirations of the standard in their everyday practice. That’s why Doctors Manitoba organized the Referral and Consultation Summit last fall, and we are preparing to release very soon the final recommendations on necessary actions to support effective physician collaboration.
Summary of the New Standards
The starting point: The original standard has been in place since January 1, 2019. This five-page standard sets out the responsibilities of both the referring and consulting physicians, including responding to a referral within 30 days to accept or decline it and provide an estimated appointment date. It also sets expectations for referral to non-traditional therapy and transfer of care in institutional settings.
What’s new: The existing standard is being replaced by three interrelated standards, including an overarching document called Collaborative Care outlines the guiding principles for all physicians, with a related standard guiding emergent, urgent, and inpatient requests, and another for non-emergent consultation requests.
What’s changing? The new standards proposed by CPSM include several changes, all intended to support clearer roles and more timely communication for both referring and consulting physicians. Key changes are summarized below.
Obligations of the referring physician: The new standard outlines what must be included in a referral, similar to the current standard. It clarifies that referrals should include a clear, relevant clinical question or reason for consultation and that the referring physicians should include relevant medical information including history, findings and test results.
Obligations of the consulting physician: The main change clarifies that consultants should generally respond within 14 days of receiving a referral, a change from the current 30 days.
- The content of the initial response has not changed substantively, notifying the referring physician if the request is accepted and an estimated appointment date. Like the current standard, if a request is declined or the patient should be seen sooner than the consultant can accommodate, the consultant should offer advice to the referring physician on other consultants to try.
- Notably, the standard clarifies that consulting physicians should have a process in place while away from the office to notify referring physicians they won’t respond within the 14-day timeframe. It also clarifies that physicians “are not directly responsible for delays in communication caused by institutional systems issues that are outside your control.”
- Reports on the outcome of the consultation are to be sent “as soon as possible but generally within 14 days (and not more than 28 days),” which is a change from the current guidance of within 30 days.
Role clarity: Similar to the current standard, the new one makes it clear that referring physicians must provide complete information including any tests or findings to support a consultation with a clear reason or question. Consulting physician practices are responsible for scheduling and notifying patients of their consultation appointments, arranging additional testing or follow-ups, and for assessing fitness for procedures.
- Ultimately, both referring and consulting physicians have an obligation to “close the loop” with each other by acknowledging receipt of each other’s messages.
Urgent, Emergent, Inpatient Requests: Like the old standards, the new ones also outline clarity for urgent/emergent requests, transfers of care, and discharges. The requirements do not change substantively, but the new standard makes it clear that physicians should be guided by shared responsibility for the patient and be respectful of each other, even going so far as to emphasize that requests should be clear and complete as well as providing examples of unacceptable behaviour or responses.
What’s Next
CPSM is asking for feedback by Friday, February 13.
- You can send feedback directly to CPSM with this survey. We encourage you to copy us at practiceadvice@doctorsmanitoba.ca, to help inform our response on behalf of the profession.
- Be sure to identify if you typically refer, consult, or both.
- If you don’t feel comfortable sending feedback directly to CPSM, you can send it to us in confidence instead.