12Primary care practitioners, concussion clinic teams/networks of providers should follow referral indicators to refer patients to appropriate specialists, services and allied professionals.
It is recognized that concussion clinics or networks of care will not have all the specialists that may be required to comprehensively manage every potential prolonged concussion symptom. It is also important for all health care professionals to acknowledge the limits of their own expertise and scope of practice, and to work collaboratively with specialized providers as needed. Collective competence increases the likelihood patients will receive the right treatment, at the right time, from the right provider.
Referral networks should be established by each primary care provider and concussion clinic, in order to make appropriate and timely referrals to additional experts as required by the needs of the patient. This also applies when interdisciplinary care is being provided by a physician/nurse practitioner in collaboration with other healthcare professionals through a network of providers. Persons can refer to themselves as concussion experts but should adhere to the specific criteria that exist for the use of this term20.
Concussion management is symptom-based and will likely involve multiple healthcare providers. It is important that qualified healthcare professionals practicing within their scope of practice are involved to ensure that appropriate treatment and supports are received for the underlying cause of the symptoms.
What this standard means:
It would be desirable to have healthcare professionals performing the core post-concussion care functions co-located (in one setting); however, it may be necessary to refer externally to other providers. Not every patient will require every service/function. Knowledge of referral indicators can guide healthcare providers to attend to, and respond to; specific patient symptoms by ensuring appropriate referrals to regulated healthcare professionals.
It is incumbent upon healthcare professionals to understand and work within their legislated scopes of practice and individual level of competency. This necessitates that referrals be made to appropriate professionals when presenting symptoms are outside a healthcare professional’s scope of practice or level of competency, or when the symptoms are not responding to a course of treatment and something else should be tried.