Discontinuing Health Services and Ensuring Continuity of Care Standard
The public can expect that when care must end, licensed healthcare professionals will explain why, provide notice if possible, and help plan for next steps. Licensed healthcare professionals will ensure that care concludes respectfully, ethically, and with minimal disruption.
This Practice Standard applies in most circumstances where the professional relationship is discontinued by the licensed healthcare professional. It does not apply where the licensee is leaving the practice, where mutually agreed-upon goals have been achieved, where the patient elects to discontinue services, or where the service was contracted to conclude upon completion of a defined time-limited or service-limited engagement. In such circumstances, licensees should refer to the relevant Ethics and Practice Standards for guidance.
While a licensed healthcare professional is not obligated to provide health services to a patient indefinitely, they cannot abandon a patient in an emergency situation or where harm may be imminent.
A licensee must:
- Discontinue the provision of health services when the therapeutic relationship is no longer viable due to clinical, ethical, safety, or personal reasons, which means to:
- Make reasonable, culturally sensitive attempts to resolve discord with a patient, unless there are safety concerns.
- Seek input from the patient and, where relevant, other healthcare providers when planning to discontinue the provision of health services, unless there are safety concerns.
- Ensure the patient’s interests are protected where a decision-maker’s request to discontinue services may pose risks to a child or vulnerable adult, and consider reporting obligations, should they arise.
- Manage their own personal risk, which means to:
- Take appropriate steps to manage any risk—such as using de-escalation strategies, safety planning, or other supports—before determining whether discontinuing provision of health services is necessary.
- Discontinue the professional relationship if the patient poses a risk of physical, psychological, or financial harm to the licensee or to others involved in the care or services.
- Communicate with a patient about the discontinuation of provision of health services, which means to:
- Provide the patient with a clear and respectful explanation for discontinuing the provision of health services.
- Provide the patient with prior written and/or verbal notice of the discontinuation of provision of health services, unless immediate discontinuation is required for safety reasons.
- Support continuity of care, which means to:
- Identify and communicate to the patient appropriate alternatives and referral options where possible.
- Document appropriately, which means to:
- Record the reasons for discontinuation of provision of health services in the patient record, including any discussions with the patient or other healthcare providers and any actions taken to assist the patient.
- Avoid abrupt discontinuation of provision of health services, which means to:
- Take reasonable steps to prevent harm to the patient as a result of the discontinuation of provision of health services.
Health service: any service or activity provided by a licensee in relation to healthcare, including collecting information; assessing, diagnosing, preventing, monitoring, treating, or managing a person’s health or health-related condition; or providing health-related information to an individual or the public, whether or not treatment is provided.
Patient: a person to whom health services are provided. Throughout the Ethics and Practice Standards, “patient” includes substitute decision-makers, parents, and guardians where applicable.
Professional relationship: the relationship that arises when a licensee, acting in their professional or practice-related capacity, provides or undertakes to provide services, advice, assessment, care, treatment, education, supervision, consultation, or other professional activities to or for an individual, a client, a patient, a family, a group, an organization, or the public.
Record: includes patient information, books, documents, drawings, photographs, letters, vouchers, papers, and any other thing on which information is recorded or stored by graphic, electronic, mechanical, or other means, but does not include a computer program or any other mechanism that produces records.