Preamble
This standard replaces the Walk-in Clinic Professional Standard.
Physicians providing episodic care are obligated to provide the appropriate care at the same standard of care that they would provide in any other setting.
In addition to respecting this standard, physicians providing episodic care must also respect the requirements of the Continuity of Care Professional Standard and, if applicable, the Virtual Care Professional Standard.
This professional standard applies to all physicians who provide primary care in the following environments: urgent care clinics, walk-in clinics, virtual care services/platforms, and any other setting that provides episodic care.
Definitions
“Cumulative patient record” means a medical record containing relevant materials from all previous visits for an individual patient accessing a clinic or platform that provides episodic care.
“Episodic care” means an isolated primary care medical encounter with a patient focused on presenting concern(s), identified medical conditions(s), where neither the physician nor the patient have the expectation of an ongoing primary care relationship.
Clinical obligations
Physicians providing episodic care must:
1. Explain the limitations of episodic care and the extent of any follow-up process that they will manage. If care is limited due to its episodic nature, it must be done so in good faith.
2. Conduct a thorough evaluation of the patient's presenting concerns and needs. An episodic one-time assessment must be as comprehensive, if not more so, than in a situation where the patient is well-known to the treating physician.
3. Have access to the New Brunswick Prescription Monitoring Program (NB-PMP) and review prescribing history in NB-PMP of any patients prescribed opioids, benzodiazepines, or other controlled substances.
4. Maintain a comprehensive patient medical record, by documenting each patient visit including, but not limited to, the patient’s relevant medical history for the presenting concern, allergies, current medications, any drug reactions, relevant family history, current health problem, assessment provided, investigations ordered, and follow up. The patient medical record should be immediately accessible to all physicians providing care to that patient in a future encounter in the clinic or care setting.
5. Order any diagnostic tests or investigations that are indicated and not refrain from ordering necessary investigations or referrals to avoid ongoing responsibility for follow-up care.
6. Provide appropriate follow-up care when requesting a diagnostic test, performing a procedure, providing treatment that requires follow-up, or making a referral, unless another health professional explicitly agrees to accept responsibility for follow-up care, in which case the transfer of care must be documented in the patient’s medical record.
7. Communicate, and document, any instructions regarding follow-up care.
8. Identify whether the patient has a primary care provider.
- If the patient has a primary care provider, the physician must provide a copy or summary of the episodic care encounter to the primary care provider, unless the patient explicitly requests otherwise.
- If the patient declines to have a record of the encounter provided to their primary care provider, the physician must provide the patient with a copy of the encounter and inform the patient of the importance of sharing records with their primary care provider.
9. Ensure that patients are directed to another health professional for medical care if the clinic or virtual care platform/clinic is closed or if they do not have a primary care provider. Posting a notice or having a telephone message containing the clinic hours and advising patients to access 811, another walk-in clinic, collaborative care centers, other virtual care options, or, in the case of an emergency, to call 911 or access the closest emergency department is sufficient to meet this standard.
Administrative obligations
Physicians who choose to provide episodic care must have administrative systems and processes in place to ensure the appropriate level of care, timely communication, and continuity of care are provided.
At a minimum, the following administrative systems must be in place in facilities, or episodic care platforms:
1. A system to review and respond to any diagnostic test results and/or consultation reports from an episodic encounter,
2. A system for registering and recording patient encounters,
3. A central source for patient medical files,
4. A cumulative patient record immediately accessible to any physician for subsequent visits,
5. Clear processes for ordering, managing, and following up on investigations and referrals or other follow up care, and
6. Access to the New Brunswick Prescription Monitoring Program (NB-PMP).
ACKNOWLEDGEMENTS
The College acknowledges the assistance of the College of Physicians and Surgeons of Alberta, the College of Physicians and Surgeons of Ontario, and the College of Physicians and Surgeons of Newfoundland in preparing this document.
AUTHORITY DOCUMENTS
Medical Act, 1981
APPROVALS
Approved by Council: October 24, 2024
Effective date: January 6, 2025
Version: Original
Last Amended: N/A
REVIEW DATE:
January 2028
