As Practice advisors, a question we receive regularly is whether there are provisions that allow healthcare professionals to discontinue services to a patient, and what are the circumstances in which this would be appropriate. Another common question is whether continuity of care must be provided in all circumstances once a healthcare professional has determined that care must end.
Regulatory framework
The Discontinuing Services and Continuity of Care Practice Standard establishes the requirements around a healthcare professional discontinuing services to a patient. It’s important to note that this Standard does not apply to when a patient has chosen to discontinue the services, or when service delivery has come to its natural conclusion (e.g. goals have been met, the patient no longer needs services). Instead, this Standard is centered around when the healthcare professional determines that discontinuation of health care services is necessary for clinical, ethical, safety or personal reasons.
A key requirement of the Standard is that healthcare professionals mustdiscontinue health services when the therapeutic relationship is no longer viable.
In situations where it is safe and reasonable to do so, healthcare professionals must attempt to manage risks and attempt to resolve disagreements with patients. If resolution is not possible, healthcare professionals must provide the rationale for discontinuation of service prior to discontinuation of services to the patient and provide options for continuity of care.
If the healthcare professional identifies that immediate discontinuation of services is necessary due to safety reasons, the healthcare professional is not required to provide prior notice of discontinuation of services. And while providing the patient with options for continuity of care is always ideal and in line with patient-centred care, in certain scenarios this may not always be reasonable or possible.
In practice
The examples below illustrate how the Standard may apply in two scenarios. Application of the Standard may change depending on clinical nuances, such as reasons for discharge and risk management assessment. Ultimately, it would be the responsibility of the healthcare professional to recognize when the therapeutic relationship is no longer viable and when provision of health services must be discontinued. Additionally, the healthcare professional would be responsible for communicating with patients and supporting continuity of care, when it is safe and reasonable to do so. And all the communication about the rationale and provision of continuity of care should be documented in the clinical record.
In one example, an occupational therapist (OT) is treating a patient with a hand injury. The patient is upset at their lack of progress and has made repeated comments to the OT (within the hearing of other patients) questioning the OT’s competence and claiming that they are making unnecessary splints to earn more money. The OT has explained the treatment prognosis and rationale for the splints to the patient several times, but the patient’s behavior has been escalating. During treatment today, the patient becomes increasingly confrontational. After the session ends, the OT considers if they or anyone else in the clinic is potentially at risk of harm if service continues in the future. After careful evaluation, they decide to discontinue care. They prepare written notification for the patient outlining the reasons and alternative options for care or referral to another healthcare provider and document the recent interaction, and the reasons for discontinuation in the clinical record.
In another example, an optician is fitting an existing patient with contact lenses because the patient’s recent prescription and lifestyle needs make eyeglasses wear unsuitable. After assessing the patient, the optician determines that the most appropriate option is a type of lens that they are not trained or experienced to fit. The optician discontinues the service while ensuring continuity of care. The optician explains to the patient why they cannot provide the fitting, discusses next steps, and arranges a referral to a suitably qualified optician or another appropriate practitioner with the requisite competencies. The optician documents the reasons for discontinuation of services, discussions with the patient, and the referral(s) to alternative practitioners in the clinical record.
About the Practice Support service
CHCPBC has profession-specific Practice Advisors for each of the nine professions the College regulates. Questions that are sent by licensees will be answered by a Practice Advisor in the same profession. Submissions are treated confidentially.
Our practice advisors provide guidance on how regulation may be interpreted and can be implemented in practice. The goal is to assist licensees to find solutions to their practice issues given the complexity of healthcare delivery today.
