✔ Make sure you have a monitored office telephone and/or voicemail system

Physicians must have an office telephone that is answered and/or allows voicemails to be left during regular business hours. (Availability and Coverage, 1)

NOTE: In a group practice, institutional, or departmental setting, there may be a common phone and voicemail system shared among a number of physicians.

Physicians must ensure that the outgoing voicemail message is up to date and accurate, indicating, for example, office hours, any closures, and relevant information regarding coverage arrangements or access to appropriate care outside of regular office hours and during temporary absences from practice. (Availability and Coverage, 2)

Physicians must ensure that voicemail messages are reviewed and responded to in a timely manner. What is timely will depend on, for example, when the message was left and the impact to patient safety that may be caused by a delay in responding.

• Physicians who offer electronic means of secure communication must similarly ensure that messages are reviewed and responded to in a timely manner. (Availability and Coverage, 3)

✔ Make sure your appointment booking structure allows patients to access timely appointments for urgent or time-sensitive issues

Physicians providing care as part of a sustained physician-patient relationship must structure their practice in a way that allows for timely access to appointments for urgent or time-sensitive issues. (Availability and Coverage, 6)

✔ Communicate with other health-care providers about patients in a timely manner as necessary

Physicians must respond in a timely manner when contacted by other physicians or health-care providers who want to communicate or request information about a patient. What is timely will depend on, for example, the impact to patient safety that may be caused by a delay in responding. (Availability and Coverage, 4)

✔ Include your professional contact information when ordering tests, writing prescriptions, and making referrals

Physicians must include their professional contact information when ordering a test, writing a prescription, or making a referral and must provide relevant coverage contact information directly to other health-care providers (e.g., laboratories, diagnostic facilities) where it is appropriate to do so. (Availability and Coverage, 5)

✔ Tell your patients where they can access care outside of your regular office hours

Physicians providing care as part of a sustained physician-patient relationship must inform patients of when and where to access appropriate care outside of regular office hours (e.g., Telehealth, local walk-in clinics, emergency department, any coverage arrangements that have been made, etc.). (Availability and Coverage, 7)

Additional Advice to the Profession from the CPSO

The legal concept of “duty of care” may require you to take additional steps to help patients access the right kind of care (e.g., post-operative follow-up, obstetrical care, etc.). Your “duty of care” will depend on your practice type. You may wish to seek legal advice for further clarity.

✔ Ensure that critical test results can be reviewed and acted upon if necessary at all times

Physicians must ensure that critical test results can be received and reviewed at all times, including outside of regular office hours and during temporary absences from practice, and that appropriate steps can be taken to notify patients if immediate emergency intervention is required. (Availability and Coverage, 11)

✔ Make reasonable efforts to arrange for another health-care provider to care for your patients while you are absent from practice

Physicians providing care as part of a sustained physician-patient relationship must make reasonable efforts to arrange for another health-care provider(s) to provide care to patients during planned temporary absences from practice. What is reasonable will depend on, for example, the length of the absence, the needs of the physicians’ patients, and the health- care provider and/or health system resources available in the community.

• If specific arrangements are made, physicians must inform patients seeking care during the temporary absence of these arrangements;
• If after reasonable efforts are made it is not possible to make specific arrangements, physicians must inform patients seeking care during the temporary absence about appropriate alternative access points of care (e.g., Telehealth, local walk-in clinics, emergency department, etc.). (Availability and Coverage, 10)

Additional Advice to the Profession from the CPSO

What is considered “reasonable efforts” to find coverage while you are away depends on a variety of factors. Other options, like informing patients about appropriate points of care (such as the emergency department) may be appropriate when you don’t have any other reasonable options.

It is also important to help patients understand the benefit of seeing physicians they have an ongoing relationship with. For example, you can help your patients understand that waiting to see their own physician (if they are able to) may contribute to continuity of care.

You can also support continuity of care by encouraging patients to develop a list of their medications and health conditions that they can share if they need to go to an emergency room, walk-in clinic, or other health-care provider.

✔ Arrange for another health-care professional to i) receive and review outstanding tests and consultation reports while you are absent from practice and ii) if necessary, provide or coordinate follow-up care

Physicians who will be unavailable during temporary absences from practice must make specific coverage arrangements with another health-care provider(s) to:

1. Receive, review, and provide or coordinate immediate care that is required during the temporary absence for all outstanding tests; and
2. Receive, review, and provide or coordinate immediate care that is required during the temporary absence for outstanding consultation reports. (Availability and Coverage, 8)

✔ Give coverage information to other health-care providers and facilities when appropriate

Physicians must include their professional contact information when ordering a test, writing a prescription, or making a referral and must provide relevant coverage contact information directly to other health-care providers (e.g., laboratories, diagnostic facilities) where it is appropriate to do so. (Availability and Coverage, 5)

✔ Ensure that critical test results can be reviewed and acted upon if necessary at all times

Physicians must ensure that critical test results can be received and reviewed at all times, including outside of regular office hours and during temporary absences from practice, and that appropriate steps can be taken to notify patients if immediate emergency intervention is required. (Availability and Coverage, 11)

✔ Arrange for someone to communicate with health-care providers about your patients as necessary while you are absent from practice

Physicians must also have a plan or coverage arrangement in place that allows other health-care providers to communicate or request information pertaining to patients under their care during temporary absences from practice. (Availability and Coverage, 9)