SPECIALTY OF ORTHOPEDIC SURGERY Delineation of Clinical Privileges

Transcription

1 SPECIALTY OF ORTHOPEDIC SURGERY Delineatin f Clinical Privileges Criteria fr granting privileges: Current certificatin in thpedics by the American Bard f thpedic Surgery r the American Ostepathic Bard f thpedic Surgery. Successful cmpletin f an ACGME r AOA, accredited pst-graduate training prgram in thpedic Surgery and bard certificatin within 5 years f prgram cmpletin. Current certificatin in thpedic Surgery by the American Bard f thpedic Surgery r the American Ostepathic Bard f thpedic Surgery and successful cmpletin f an ACGME r AOA, accredited pst-graduate training prgram in Pediatric thpedic Surgery. Successful cmpletin f an ACGME r AOA, accredited pst-graduate training prgrams in thpedic Surgery and Pediatric thpedic Surgery and bard certificatin within 5 years f prgram cmpletin. If Pediatric thpedic Surgery training was btained infrmally, dcumentatin f adequate experience. Applicants will be requested t prvide dcumentatin f practice and current clinical cmpetence as defined n the attached cmpetency grid. Applicants have the burden f prducing infrmatin deemed adequate by the hspital fr a prper evaluatin f current clinical cmpetence, and ther qualificatins and fr reslving any dubts. Current Clinical Cmpetence - MLH In additin t the required educatin, experience and/r training specified n each DOP (Delineatin f Privilege) frm, dcumentatin f current clinical cmpetence is required. Current clinical cmpetence is described as having perfrmed the privilege recently and perfrmed it well. Current clinical cmpetence is assessed prir t granting privileges initially and is reassessed when renewing privileges at reappintment fr maintenance f privileges. Current Clinical Cmpetence (CCC) may be lcatin specific (acute hspital care/surgery center (ASC) and/r age specific (adult, pediatric, nenatal). This shuld nt be cnfused with Fcused Prfessinal Practice Evaluatin (FPPE) FPPE: an evaluatin f clinical cmpetence f all new privileges as perfrmed at the specific licensed MLH facility (MHMH, MHOBH) fr which they have been initially granted. This applies t privileges fr all new applicants as well as t new/additinal privileges fr current members. Bth FPPE and current clinical cmpetence assessments are privilege-specific. FPPE is cnducted during the perid after granting new/additinal privileges. FPPE must ccur at the MLH facility(ies) where privileges/membership are held. Current clinical cmpetence may be evaluated frm case lgs prvided by nn-mlh facilities. Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 1

2 Current Clinical Cmpetence: Requirements fr New Applicants If applying directly frm training, r based n the training received in a frmal training prgram, prvider shuld submit case* lgs frm the prgram authenticated by the prgram directr alng with their recmmendatin attesting t the cmparable training, experience and qualificatins relative t the criteria fr the clinical privileges requested. If applying mre than 1 year after training cmpletin, submit the fllwing: Aggregate data frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 diagnsis cdes and the number f patients per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Prcedure list frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Case lgs (see specificatins belw) fr any special privileges requested that meet the criteria specific fr the number f prcedures defined fr current clinical cmpetence. Current Clinical Cmpetence: Maintenance f Privileges fr Current Members Fr active staff members: MLH surce data will be aggregated t review cases and prcedures perfrmed. and/r special privileges, the practitiner will be required t submit additinal case lgs frm ther facilities. If this des nt meet the minimum requirement fr cre Fr curtesy staff members with lw activity and fr certain active staff with activity that has diminished and is nw lw: Department chair recmmendatin shuld be btained frm their primary facility; and the practitiner shuld submit the fllwing: Aggregate data frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 diagnsis cdes and the number f patients per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Prcedure list frm acute care r surgery center facility fr the previus 12 mnth time perid, identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Case lgs (see specificatins belw) fr any special privileges requested that meet the specific number f prcedures defined fr current clinical cmpetence. Case Lgs All required case lgs and/r prcedure lists must cntain the fllwing infrmatin at a minimum: Date, patient identifier, CPT/ICD prcedure cde, diagnsis, cmplicatins, and dispsitin, and the facility name, name/title f the persn authenticating the lg, signature, date signed, and cntact infrmatin. If the infrmatin requested is nt available, please prvide an explanatin. *A case is defined as an episde f care either cgnitive r prcedural. Fr interpretive care, case is interpretatin f ne diagnstic study. Onging Prfessinal Perfrmance Evaluatin (OPPE) OPPE is evaluated peridically (mre frequently than annually) in the facility where membership/privileges are held. T assure OPPE requirements are satisfied, the practitiner must peridically exercise the privileges in the MLH facility(ies) where he/she has membership. OPPE must ccur regularly n patient encunters in the MLH facility(ies) where privileges/membership are held. Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 2

3 Specialty/Prcedure Delineatin f Privilege Frm Educatin/Training Dcumentatin fr Initial Granting Initial Applicatin (Prf f current clinical cmpetence) FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) Maintenance Requirements thpedic Surgery Cre Current certificatin by the American Bard f thpedic Surgery r The American Ostepathic Bard f thpedic Surgery. Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in thpedic Surgery and bard certificatin within 5 years f cmpletin. Aggregate data frm primary practice facility fr the previus 12 mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Prcedure list frm primary practice facility fr the previus 12 mnth time perid identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. MLH Data will be btained fr active members when available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Percutaneus Vertebrplasty Balln Kyphplasty Autlgus Chndrcyte Implantatin Stablizatin Device Surgery fr the Spine Successful cmpletin f an ACGME- r AOAaccredited residency prgram in rthpedic surgery, fllwed by a fellwship in spine surgery, and cmpletin f an accredited curse in kyphplasty with a minimum f 7 hurs CME, which includes didactic and labratry training. Successful cmpletin f an ACGME- r AOAaccredited residency training prgram in rthpedic surgery as well as a fellwship prgram in sprts medicine r arthrscpy. In additin the applicant must have cmpleted a Genzyme advanced curse in ACI that included prctred cases. Successful cmpletin f a frmal pstgraduate educatin training prgram in which perfrmance f at least 4 prcedures in the previus 12 perfrmance f at least 2 prcedures in the previus 12 perfrmance f at least 10 First 3 cases First 2 cases Department chair recmmendatin will be btained frm primary practice facility. perfrmance f at least 8 prcedures in the previus 24 perfrmance f at least 2 prcedures in the previus 24 perfrmance f at least 10 prcedures within the previus 24 Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 3

4 Specialty/Prcedure Delineatin f Privilege Frm Educatin/Training Dcumentatin fr Initial Granting Initial Applicatin (Prf f current clinical cmpetence) FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) Maintenance Requirements Micrvascular Surgery Endscpic carpal tunnel decmpressin Intradiscal Injectins Pharmaclgic Blcks and Therapy Vascular Grafts f the Hand And frearm the applicant received training in spine surgery, and dcumented by the training directr. Successful cmpletin f a frmal pstgraduate educatin training prgram in which the applicant received training in micrvascular surgery, and dcumented by the training directr, which wuld meet the prctring criteria. Successful cmpletin f an accredited curse in cmplex hand surgery prcedures, which includes didactic and labratry training. Curse shuld prvide 50 categry 1 CME hurs. Successful cmpletin f an accredited curse in endscpic carpal tunnel decmpressin prcedures, which includes didactic and labratry training. Curse shuld prvide 8 Categry 1 CME hurs. Successful cmpletin f an accredited curse in intradiscal injectin prcedures, which includes didactic and labratry training. Fifty prcedures perfrmed shuld be dcumented. Prctr shuld cmplete an evaluatin cnfirming supervisin, and evaluatin f skills. Successful cmpletin f an accredited curse in the prcedures, which includes didactic and labratry training. Fifty prcedures perfrmed shuld be dcumented. Prctr shuld cmplete an evaluatin cnfirming supervisin, and evaluatin f skills Successful cmpletin f a frmal pstgraduate educatin training prgram in which the applicant received training in vascular grafts, and dcumented by the training directr, which wuld meet the prctring criteria.] Successful cmpletin f an accredited curse in vascular graft prcedures, which includes didactic and labratry training. Curse shuld prvide 50 Categry 1 CME hurs. Prctr prcedures under prctr (evaluatin included) perfrmance f at least 15 prcedures under prctr (evaluatin included) perfrmance f at least 5 prcedures in the previus 12 perfrmance f at least 10 prcedures in the previus 12 perfrmance f at least 6 prcedures in the previus 12 perfrmance f at least 5 prcedures under prctr (evaluatin included) perfrmance f at least 5 prcedures in the previus 24 perfrmance f at least 5 prcedures in the previus 24 perfrmance f at least 10 prcedures in the previus 24 perfrmance f at least 10 prcedures in the previus 24 perfrmance f at least 5 prcedures within the previus 24 Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 4

5 Specialty/Prcedure Delineatin f Privilege Frm Educatin/Training Dcumentatin fr Initial Granting Initial Applicatin (Prf f current clinical cmpetence) FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) Maintenance Requirements Spinal Instrumentatin Adult t include sclisis surgery in adults thpedic Surgery Pediatric Cre shuld cmplete an evaluatin cnfirming supervisin, and evaluatin f skills. Successful cmpletin f an ACGME- r AOAaccredited fellwship training prgram in spinal instrumentatin, which include trauma and recnstructin f the spine. Prctr shuld cmplete an evaluatin cnfirming supervisin, and evaluatin f skills. Current certificatin by the American Bard f thpedic Surgery r The American Ostepathic Bard f thpedic Surgery. Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in thpedic Surgery and bard certificatin within 5 years f cmpletin. perfrmance f at least 5 prcedures within the previus 24 OR Five (5) successfully prctred cases as evidenced by prctr evaluatin frms Aggregate data frm primary practice facility fr the previus 12 mnth time perid indentifying the tp 10 diagnsis cdes and the number f inpatients per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Prcedure list frm primary practice facility fr the previus 12 mnth time perid identifying the tp 10 CPT/ICD cdes and the number f prcedures per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. perfrmance f at least 5 prcedures within the previus 24 MLH Data will be btained fr active members when available, the applicant shuld supply additinal case lgs frm ther facilities HIM departments, if necessary, t meet the minimum requirement(s) t be cnsidered fr the privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. Aggregate data submitted shuld include the tp 10 diagnsis cdes, with the number f inpatients per cde, and prcedure lists indicating the tp 10 CPT/ICD cdes, with the number f prcedures per cde fr the previus 12. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Sclisis Surgery Pediatric Successful cmpletin f an ACGME- r AOAaccredited residency r fellwship training prgram in pediatric rthpedic surgery, r if training was btained infrmally, dcumentatin f experience and case lg perfrmance f at least 10 prcedures within the previus 24 Department chair recmmendatin will be btained frm primary practice facility. perfrmance f at least 10 prcedures within the previus 24 Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 5

6 Specialty/Prcedure Delineatin f Privilege Frm Educatin/Training Dcumentatin fr Initial Granting Initial Applicatin (Prf f current clinical cmpetence) FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year) Maintenance Requirements shuld be included with dcumentatin. Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 6

7 thpedic Surgery Cre Privilege: Admit, evaluate, diagnse, prvide cnsultatin and care t patients abve the age f 2 years, except as specifically excluded frm practice, t crrect r treat varius cnditins, illnesses and injuries f the extremities, spine, and assciated structures by medical, surgical, and physical means including but nt limited t cngenital defrmities, trauma, infectins, tumrs, metablic disturbances f the musculskeletal system, defrmities, injuries, and degenerative diseases f the spine, hands, feet, knee, hip, shulder, and elbw including primary and secndary muscular prblems and the effects f central r peripheral nervus system lesins f the musculskeletal system. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. The cre privileges in this specialty include the prcedures n the attached list and such ther prcedures that are extensins f the same techniques and skills. General thpedic Clinical Care Majr Trauma treatment Malignant rth tumr treatment Treatment f stemyelitis Treatment f rthpedic cnditins Diagnstic thpedic Prcedures Jint aspiratin Needle bipsy Arthrscpy Electrmygraphy Discgraphy Myclgraphy Therapeutic thpedic Prcedures Repair f laceratins Remve freign bdy Clsed fractures-set and cast Manipulatin f jints Injectin f jints Drain infectin Amputatin f extremities Open fractures - treatment f Tendn repair Tendn transplant Peripheral nerve repair Skin grafting Hemipelvectmy Scapulthracic amputatin Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 7

8 Laminectmy Spinal fusin Recnstructive surgery Hand recnstructin Vertebrectmies Anterir spinal fusin Limb salvage prcedures Allgraft prcedures Ttal jint replacement-shulder Ttal jint replacement-elbw Ttal jint replacement-wrist Ttal jint replacement-hand Ttal jint replacement-hip Ttal jint replacement-knee Ttal jint replacement-ankle Ttal jint replacement-ft Other arthrplasty Arthrdesis General Cmmunity Pediatric thpedic Care Clsed and Open Fractures Bne and Jint Infectins Multiple Trauma Neplasms Cngenital Anmalies Myelmeningcele Metablic Bne Disrders Rheumatalgic Disrders Ostechndrsis thpedic Surgery Pediatric Cre Privilege: Admit, evaluate, diagnse, cnsult and medical and surgical care f children including nenates with disrders, diseases and injuries f the extremities, pelvis, shulder, girdle, and spine. Privileges include but are nt limited t treatment f fractures, dislcatins, arthritis, and ther diseases f jints; infectins, tumrs, tumr-like lesins, and metablic diseases f the bne, jint, tendn, tendn sheath, fascia, bursa and nerves; cngenital, traumatic, infectius, pstural, develpmental, neurgenic and metablic defrmities and diseases including: recnstructive surgery in children t crrect traumatic, pstural, cngenital, neurgenic, arthritic, and idipathic defrmity r diseases f the extremities, spine r pelvis; perative and nn-perative treatment f abrasins, cntusins, hematmas and laceratins (bth superficial and deep) anywhere abut the bdy. This wuld als include the administratin f lcal r reginal anesthesia when necessary. Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 8

9 Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Diagnstic/therapeutic mdalities & prcedures permitted are:. Clsed and Open Fractures Bne and Jint Infectins Multiple Trauma Neplasms Cngenital Anmalies Limb length unequality-pediatric Myelmeningcele Metablic Bne Disrders Rheumatlgic Disrders Ostechndrsis. Specialized Cerebral Palsy prcedures-pediatric Special: The physician requesting special privileges must meet the minimum criteria fr the specialty cre and demnstrate the apprpriate pst graduate training and/r demnstrate successful cmpletin f an apprved, recgnized curse when such exists, r ther acceptable experience. Administratin f mderate sedatin: See Credentialing Plicy fr Sedatin and Analgesia by Nn-Anesthesilgists. Requires: Separate DOP, ACLS, NRP r PALS certificatin Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 9

10 thpedic Surgery Clinical Privileges Check belw the particular privileges desired in thpedic Surgery fr each facility: Please check () applicable age categries fr each privilege requested. Privilege Descriptin Age Limitatins thpedic Surgery Cre thpedic Surgery Pediatric Cre Special Privileges Percutaneus vertebrplasty r balln kyphplasty Autlgus chndrcyte implantatin Endscpic carpal tunnel decmpressin Stabilizatin device surgery fr spine Micrvascular surgery Spinal Instrumentatin-Trauma & Recnstructin-Adult- includes sclisis surgery in adults Intradiscal injectin f substances, including Chympapain, fr diagnstic purpses, pain, and cnfirm neurlgical syndrmes Pharmaclgic blcks and therapy Vascular grafts f the hands and frearm Sclisis surgery-pediatric Methdist Healthcare Memphis Hspitals (MHMH) Germantwn, Le Bnheur Medical Center, Nrth, Suth & University, Outpatient Clinics & Diagnstic Facilities Nenates (0-28 days) Infants (29 days 2 Years) Children & Adlescents (2-18 years) Included & Limited t General Cmmunity Pediatrics Adults & Adlescents (13 & Abve) Methdist Healthcare Olive Branch Hspital (MHOBH) Adults & Adlescents (13 & Abve) Limitatins Clinical privileges are granted nly t the extent privileges are available at each facility. Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 10

11 Darkly shaded areas represent privileges nt available t any practitiner due t the privilege nt being ffered by the facility. Acknwledgement f practitiner I have requested nly thse privileges fr which by educatin, training, current experience and demnstrated perfrmance I am qualified t perfrm and fr which I wish t exercise at the facilities indicated abve, t the extent services are available at each facility, and I understand that: (a) in exercising any clinical privileges granted, I am cnstrained by facility and medical staff plicies and rules applicable generally and any applicable t the particular situatin (b) any restrictin n the clinical privileges granted t me is waived in an emergency situatin and in such situatin my actins are gverned by the applicable sectin f the medical staff bylaws r related dcuments Physician's Signature Date Printed Name Bard apprved: March, 2011, Revised 6/17/13, 8/15/18 11