Responsibility for Post-Surgical Care - Standards & Guidelines College of Physicians & Surgeons of Nova Scotia

Professional Standards Regarding the Responsibility for Post-Surgical Care

Preamble

The delivery of post-surgical care must put the needs of the patient first. Furthermore, the responsibility for post-operative care of patients must be clear to the patient and the medical team. It has long been a source of tension and uncertainty within medicine, generating friction between physicians performing an operation or procedure, primary care providers, and emergency departments. As a result of uncertainty and inconsistent practice, patients are often confused as to who is responsible for their post-operative care.

This document provides direction to physicians performing an operation or procedure regarding their post-operative responsibilities. This document is to be read in conjunction with the College’s Professional Standards Regarding Transfer of Care.

Professional Standards

Unless the care has been transferred in accordance with the College’s Professional Standards Regarding Transfer of Care, the physician performing an operation or procedure is the most responsible physician (MRP) for patients while admitted to hospital following surgery.

As described by the Canadian Medical Protective Association, the term Most Responsible Physician (MRP) refers to the physician who has overall responsibility for directing and coordinating the care and management of a patient at a specific point in time.

With respect to post-operative care, upon discharge, the physician performing an operation or procedure must:
1. Ensure the patient is provided clear instruction about post-surgical care, including:
  1. follow-up appointments;
  2. outpatient investigations; and
  3. their contact information, or that of their service or delegate, together with guidance as to potential complications or concerns that should prompt the patient to contact them;

Throughout this document, wherever applicable the term “patient” includes the designated substitute decision maker of the patient.

Must only delegate post-surgical care to the primary care provider with the agreement of the primary care provider. The physician performing an operation or procedure remains responsible for any necessary follow-up care until the primary care provider agrees to accept responsibility for follow-up care;
If unavailable for follow-up care, arrange transfer of post-operative care to a designated physician or healthcare professional who is available and has the expertise to provide the necessary follow-up care; and
Provide to the primary care provider all necessary clinical and administrative information to assist, guide, and inform the ongoing post-operative care of the patient. The information needs to be provided in a timely manner aligning with the anticipated needs of the patients.

Ideally, all such information will be set out in the Discharge summary. In the event where Discharge summaries or other discharge documents will not be received by the primary care provider in a timely manner, the physician performing an operation or procedure will need to take other steps to provide the primary care provider with the necessary information.

Resources

Canadian Medical Protective Association

Acknowledgements

The development of this College standard was informed by the College of Physicians and Surgeons of Ontario’s Transitions in Care and its Advice to the Profession: Continuity of Care documents.

Document History

Approved by the Council of the College of Physicians and Surgeons of Nova Scotia: October 18, 2024

Date of next review: 2027