The
operative procedure is only one part of the total surgical care of
the patient. Total surgical care includes establishing
or confirming the diagnosis, preoperative preparation, the
operative procedure, and postoperative care whether the patient is
admitted or an outpatient having day surgery. Ideally,
the patient should receive all of these services from the surgeon
and the anaesthesiologist to whom the patient entrusts his or her
care.
Continuity of care
is dependent upon physician availability. When care is
provided by a physician who is not a resident in the community,
gaps in care can occur. These gaps can be minimized
through appropriate provisions for coverage. In those
hospitals where visiting surgeons and anaesthesiologists are part
of a surgery outreach program, specific rules and regulations must
be adopted to ensure that gaps in care associated with itinerant
surgery do not occur. Generally, a visiting surgeon is
unavailable to provide regular follow-up care.
Therefore, visiting surgeons must have a working relationship with
physicians practicing in the area in order to identify who will
provide care when the visiting physician is not in the
community. This would include timely communication on a
regular basis. Anaesthesia services may or may not be
provided by a physician practicing in the area.
The visiting surgeon shall submit a proposal in writing to the
facility chief of staff outlining:
| a. |
the nature of the procedures to be performed, |
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| b. |
significant features of pre, intra, and postoperative care
given by other health care professionals, including nursing,
pharmacy, and diagnostic services. |
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| c. |
a written agreement with area physician(s) to
provide anaesthesia intraoperatively and to conduct preoperative
anaesthesia assessments. If the anaesthesiologist is a visiting
physician, his or her role is typically limited to immediate
preoperative, intraoperative, and immediate postoperative care.
Area physicians would conduct preoperative anaesthesia
assessments. |
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| d. |
a written agreement with the attending community
physician(s) who will be responsible to provide postoperative care
both in hospital and in the community. The attending
physician assumes all aspects of patient care unless specific
arrangements are made. The agreement also confirms that
the attending community physician(s) is familiar with the surgical
procedure performed, and is able to recognize and initiate
treatment for complications which may occur. |
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| e. |
a process that ensures availability of the visiting surgeon or
back-up in an emergency including:
i. Operating surgeons must provide contact information
so they can be quickly contacted when the attending community
physician providing the postoperative care requires advice from an
operating surgeon who has left the community. If the
operating surgeon is a member of a clinic or call group who share
after hours calls, the physicians assuming call responsibility must
be aware of and agree to take on the responsibility for the
operating surgeon's work in the regional hospital.
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ii. In the event that a patient requires admission
to a higher level care facility than the regional hospital, the
visiting surgeon must agree to accept responsibility for the
patient, or if the visiting surgeon does not hold the necessary
hospital admitting privileges, written arrangements must be in
place to ensure that another surgeon with appropriate privileges
will accept responsibility for the patient. |
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| f. |
confirmation from the facility manager, in consultation with the
Chief of Staff, that the facilities (including physical plant,
equipment, and supplies) and skill levels of the entire hospital
health care team are commensurate with the care required to support
the surgery to be performed.
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Prior to slating surgery, the visiting surgeon must see and
assess the patient and personally make the decision to
proceed. The assessment must include the formulation of
a surgical diagnosis and the nature of the assessment and the
diagnosis must be properly recorded in a hospital record. The
visiting surgeon is required to obtain informed patient
consent. |
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A preoperative anaesthesia assessment must be
completed. Anaesthesia consent must be obtained by the
physician who will be providing anaesthesia. |
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All preoperative diagnostic work plus appropriate documentation
of patient consent must be on file on the hospital record before
the procedure is carried out. |
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The visiting physicians must hold full licenses with
CPSM. Only procedures approved by the Regional Health
Authority may be performed. A list of all privileges at
the facility is required to be provided annually to the Area
Standards Committee (Hospitals Act Regulation). |
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The medical staff shall maintain an ongoing chart audit of all
procedures performed. Visiting surgeons and
anaesthesiologists shall participate in the audit process to the
extent possible. If they attend the facility regularly,
audits should be scheduled for when visiting physicians are on
site. If they attend the facility irregularly, it would
be appropriate to have written communication between visiting
physicians and the audit committee. The results of audits should be
reported regularly to the Area Standards
Committee. Any Critical Clinical
Occurrences must be reported according to the requirements of the
Regional Health Authorities Act and the policy of the
CPSM. In addition, the program shall be reviewed as
part of the CPSM hospital review program. |
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A statement is a formal position of the College with
which members shall comply.
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