Transcript: Recording Consultations & Transfers of Care in the BIS Infographic

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Consultation

A request for clinical assessment and advice from a physician or a nurse practitioner.

Transfer of care (T-O-C) 

The transfer of responsibility from a midwife to a physician as the most responsible provider (M-R-P) for part, or all, of the duration of the client’s care. When a T-O-C occurs, the physician becomes the M-R-P.

Only record consultations and T-O-C that occurred with a physician or a nurse practitioner.¹

A midwife may engage in collaborative care with a physician, but there can only be one M-R-P at any given time.

A routine epidural² would not be considered a consult if there is no involvement of any physician other than the anesthesiologist.

Where to record

Below are some examples of consultations/T-O-C that may occur in each encounter.³

Antenatal General: during pregnancy including early labour prior to active labour.

              Examples: GDM, PPROM

Labour & Birth: from onset of active labour to approximately 1-hour post-birth.

              Examples: 4th degree tear, PPH

Postpartum Birthing Parent⁴: approximately 10 hours post-birth to discharge from midwifery care.

              Examples: Incision infection, mastitis

Birth Child: within approximately the first hour of birth.

              Examples: birth injury. Meconium aspiration

Postpartum Child: from approximately 1 hour post-birth to discharge from midwifery care.

              Examples: hyperbilirubinemia, weight loss > 10%

What about induction?

Although inductions occur before active labour, they are integral to the process of labour and birth and any consult/TOC related to them should be recorded in the Labour & Birth Encounter.

What to select

Always select the primary clinical indication/complication as the reason for a consultation/T-O-C regardless the clinical intervention.³

More questions?

General B-I-S F-A-Q

Consults/T-O-C F-A-Q

Midwives Scope of Practice F-A-Q

Footnotes

¹Consults with other health care professions (ex. Massage therapist, naturopathic doctor etc.) should not be recorded. Midwife-to-midwife consults and T-O-C do happen but are not yet recorded in the BIS. A place to record midwife-to-midwife consults/T-O-C may in included in future BIS updates.

²A routine epidural is performed or clients that do not have complex, obscure or serious clinical complication; clients of this nature may require a consult/T-O-C. Click here for more guidance on recording epidurals.

³The examples displayed here will not be applicable to all midwives. Scope of practice may vary; midwives should assess their own knowledge skills, and judgement to determine when it is appropriate to consult or transfer care.

⁴The encounter is entitled “Postpartum Maternal” in BORN. In attempt to maintain gender inclusive language, the A-O-M has chosen to refer to this encounter as “Postpartum Birthing Parent” for the purposes of this infographic.