■ Safety of care:
Improving patient safety and reducing risks
Being on call when resources are limited
Originally published March 2008; Revised November 2018
The following article applies in normal circumstances. For more information specific to the COVID-19 pandemic, see the CMPA COVID-19 Hub.
On-call consulting physicians frequently receive requests, from either within their hospital or from other institutions, to arrange care or transfer of a patient. These physicians may have concerns about providing advice when they are unable to accept the patient due to a lack of resources, and consequently cannot directly provide the investigation or therapy the patient may require. These concerns stem from a possible misunderstanding that, by accepting a call and providing advice, the liability of the consultant may be greater than refusing the call in the first place.
When resources are scarce, the level of care the consultant can reasonably provide may also be affected. Nevertheless, this does not generally mean the consultant should avoid providing advice to other physicians (within or outside their hospital) or participating in the care of patients in their hospital.
What CMPA members tell us—a few examples
- A chief of staff is informed that on-call physicians in the hospital are refusing to speak with referring physicians when a shortage of beds precludes admitting the patient. The refusals stem from a belief that, by accepting the call and providing advice, and if the direction and advice could not be provided at the referring physician's site, the on-call consultant might risk increased liability.
- The director of an emergency department reports that on-call intensivists and cardiologists are refusing to assist in the management of critically ill patients in their own emergency department when ICU beds are unavailable.
- The director of a critical-care patient placement service is concerned that on-call specialists in urban centres are refusing to provide advice for the management and transport of critically ill patients residing in areas where specialist expertise is lacking, and where the specialists' hospital cannot provide an ICU bed or an operating room.
Obligations and liability
The courts and regulatory authorities (Colleges) might consider that, once contacted about a potentially emergent patient, the on-call consultant owes a duty of care to that patient. Should a patient safety incident result from a failure to either take the call or provide advice, the risk of liability may be as great or greater than if appropriate advice and direction had been provided to the referring physician. In responding to specific physician concerns, some Colleges have indicated that consultants should at least provide direction to the referring physician, regardless of whether a transfer of the patient is possible.
The bottom line
When receiving requests from referring physicians for professional advice, on-call consultants should keep in mind the following:
- Give your professional opinion and advice only when you have sufficient clinical information on the individual case and are qualified to comment.
- Where possible, document the information you considered and your recommendations. While in some cases you may be constrained by factors such as whether you know the patient’s name and whether you have access to the patient’s medical record, your hospital or institution may have policies or protocols for documentation in these circumstances.