■ Safety of care:
Improving patient safety and reducing risks
Being on call when resources are limited
Published: March 2008
Revised: November 2022
The information in this article was correct at the time of publishing
On-call consulting physicians frequently receive requests, from 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 care that the patient may require. These concerns might stem from a misunderstanding that, by providing advice, the liability of the consultant may be greater than it would be if they had instead refused the call outright. However, it is important to understand that, when resources are scarce, the level of care that the consultant would be reasonably expected to provide may be affected.
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. Some Colleges have indicated that consultants should at least provide advice to the referring physician, or where possible, provide suggestions for alternative care providers who may be able to accept the patient transfer.
Remember that, when receiving requests from referring physicians for professional advice, on-call consultants should give their professional opinion and advice only when they have sufficient clinical information on the individual case and are qualified to comment. It is ideal to document the information considered and recommendations whenever possible. While in some cases a physician may be constrained by factors such as whether they know the patient’s name and whether they have access to the patient’s medical record, the hospital or institution may have policies or protocols for documentation in these circumstances.