SPECIALTY OF ANESTHESIOLOGY Delineation of Clinical Privileges

Transcription

1 SPECIALTY OF ANESTHESIOLOGY Delineatin f Clinical Privileges Criteria fr granting privileges: Current certificatin by the American Bard f Anesthesilgy, r the American Ostepathic Bard f Anesthesilgy. Or Successful cmpletin f an ACGME, r AOA accredited pst-graduate training prgram in anesthesilgy and bard certificatin within 5 years f prgram cmpletin. 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. TJC (The Jint Cmmissin) describes current clinical cmpetence 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 FPPE (Fcused Prfessinal Practice Evaluatin) 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. 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. Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 5/17/2017 1

2 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. OPPE (Onging Prfessinal Perfrmance Evaluatin) The Jint Cmmissin (TJC) requires OPPE 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, 4/16/14, 5/17/2017 2

3 Specialty/Prcedure Delineatin f Privilege Frm Anesthesilgy Cre Educatin/Training Dcumentatin fr Initial Granting Current certificatin by the American Bard f Anesthesilgy, r the American Ostepathic Bard f Anesthesilgy. Or Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Anesthesilgy and bard certificatin within 5 years f cmpletin. Initial Applicatin (Prf f current clinical cmpetence) Prcedure list frm primary practice facility fr the previus 12 mnth time perid identifying the tp 10 CPT/ICD9 cdes and the number f prcedures per cde. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Case lg frm primary practice facility dcumenting 250 hspital cases in previus 12 mnths. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. FPPE Validatin f cmpetence after appintment and/r granting f a new r additinal privilege (T be cmpleted within ne year), management f difficult airway & CV cases Maintenance Requirements 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 Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the 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 mnths. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Advanced Pediatric Anesthesia Successful cmpletin f an ACGME r AOA accredited pst-graduate training prgram in Anesthesilgy, plus additinal pst-graduate training in pediatric anesthesilgy, and bard certificatin within 5 years f cmpletin. Case lg frm primary practice facility dcumenting 100 hspital cases in previus 12 mnths. First 10 cases, General Anesthesia - Children 2 yrs and yunger (5 cases); Children ver 2 yrs (5 cases) Department chair recmmendatin will be btained frm primary practice facility. 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 Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 5/17/2017 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 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 mnths. Any cmplicatins/pr utcmes shuld be delineated and accmpanied by an explanatin. Cmmunity Pediatric Privileges Chrnic Pain Management Liver Transplant Anesthesia (Adult) Demnstrated cmpetence in prviding ASA 1 & 2 level pediatric anesthesia Case lg frm primary practice facility dcumenting 5 prcedures within the previus 12 mnths Case lg frm primary practice facility dcumenting 100 hspital cases within the previus 12 mnths. Prctr evaluatins fr five successful cases OR Letter dcumenting prctring frm physician t the credentialing ffice with specific references t the required cmpetencies. TEE Basic Dcument 20 CME hurs Case lg dcumenting 150 exams studied, 50 prctred prcedures under direct supervisin TEE Advanced Hld current TEE Basic privileges and dcument 50 CME hurs Case lg dcumenting 300 exams studies, 150 prctred prcedures under direct supervisin Department chair recmmendatin will be btained frm primary practice facility. Case lg dcumenting 5 prcedures within the previus 12 mnths Aggregate data fr tp 10 diagnsis cdes, and prcedure list btained frm MLH surces.. Case lg dcumenting 8 prcedures within the previus 12 mnths Case lg dcumenting prcedures within the previus 24 mnths Case lg dcumenting prcedures within the previus 24 mnths Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 5/17/2017 4

5 Anesthesilgy Cre Privilege: Admit, evaluate, diagnse, cnsult, and prvide care management f patients f all ages except as specifically excluded frm practice, rendered uncnscius r insensible t pain and emtinal stress during surgical, bstetrical and certain ther medical prcedures; including preperative, intraperative and pstperative evaluatin and treatment; the supprt f life functins and vital rgans under the stress f anesthetic, surgical and ther medical prcedures; medical management and cnsultatin in pain management and critical care medicine, direct resuscitatin in the care f patients with cardiac r respiratry emergencies, including the need fr artificial ventilatin, pulmnary care, supervisin f patients in pst-anesthesia care units and critically ill patients in special care units. Access, stabilize and determine dispsitin f patients with emergency cnditins cnsistent with the Medical Staff plicy regarding emergency r cnsultative services. Airway management, sleep apnea, anterir mediastinal mass, and fiberptic brnchscpy Anesthesia fr laser surgery f the airway Arterial and central venus cannulatin Diagnstic and therapeutic management f acute and chrnic pain Fiberptic laryngtrachebrnchscpy and intubatin General anesthesia, including invasive mnitring; respiratry therapy, including lng-term ventilatry supprt; and airway management, including cricthyridtmy Limited critical care Lcal and reginal anesthesia with and withut sedatin, including tpical, and infiltratin, minr and majr nerve blcks, intravenus blcks, spinal, epidural, and majr plexus blcks and peripheral nerve blcks t include indwelling catheters Slid Organ Transplant Anesthesia, excluding liver Management f cmmn intraperative prblems Management f cmmn PACU prblems Management f acute periperative pain Management f fluid, electrlyte, and metablic parameters Management f hypvlemia frm any cause Management f malignant hyperthermia Manipulatin f cardivascular parameters Management f acute pstperative pain including use f piids, adjuvant medicatins, and varius nerve blck mdalities Mderate and deep sedatin Obstetric anesthesia Preperative evaluatin/anesthetic Pulmnary artery catheter insertin and management cnsultatin Resuscitatin f patients Sedatin/mnitred anesthetic care Single lung anesthesia Cardiac anesthesia Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 5/17/2017 5

6 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. Cmmunity Pediatric Privileges Admit, evaluate, diagnse, cnsult, and prvide care management f pediatric (ages 2-13 years) patients rendered uncnscius r insensible t pain and emtinal stress utilizing varius pediatric sedatin, general r reginal anesthesia, place and use f invasive mnitrs (including arterial, central venus, and pulmnary artery catheters,) during surgical and certain ther medical prcedures, limited t ASA classificatins 1 and 2; including pre-, intra-, and pstperative evaluatin and treatment, supprt f life functins and vital rgans under the stress f anesthetic, surgical and ther medical prcedures, medical management and cnsultatin in pain management and critical care medicine, direct resuscitatin in the care f patients with cardiac r respiratry emergencies, including the need fr artificial ventilatin and pulmnary care, Advanced Pediatric Care Privileges: Admit, evaluate, diagnse, cnsult, and prvide care management f pediatric (ages nenate t 18 years) patients rendered uncnscius r insensible t pain and emtinal stress utilizing varius pediatric sedatin, general r reginal anesthesia, place and use f invasive mnitrs (including arterial, central venus, and pulmnary artery catheters,) during surgical and certain ther medical prcedures; including pre-, intra-, and pstperative evaluatin and treatment, supprt f life functins and vital rgans under the stress f anesthetic, surgical and ther medical prcedures, medical management and cnsultatin in pain management and critical care medicine, direct resuscitatin in the care f patients with cardiac r respiratry emergencies, including the need fr artificial ventilatin, pulmnary care, and supervisin f pediatric patients in the nenatal ICU and Well Newbrn Nurseries. Anesthesilgy Cre (0-18 years) Cardiac Anesthesia Single lung anesthesia Liver Transplantatin Chrnic Pain Management: Admit, evaluate, diagnse, cnsult, and prvide cmprehensive management f chrnic and/r cancer pain utilizing a brad range f peripheral nerve blck prcedures, epidural and subarachnid injectins, jint and bursal sac injectins, crytherapeutic techniques, epidural, subarachnid, r peripheral neurlysis, electrical stimulatin techniques, implanted epidural and intrathecal catheters, prts, and infusin pumps; acupuncture and acupressure, hypnsis, stress management, and relaxatin techniques, trigeminal ganglinectmy, peripheral neurectmy and neurlysis, sympathectmy techniques, alternative pain therapies and management f lcal anesthetic verdse including airway management and resuscitatin; management f therapies, side effects and cmplicatins f pharmaclgic agents used in pain management. Liver Transplant (Adult) TEE (Basic) TEE prbe placement and intraperative mnitring TEE (Advanced) Diagnstic Bard apprved: March, 2011, Revised 6/17/13, 4/16/14, 5/17/2017 6

7 Anesthesilgy Clinical Privileges Check belw the particular privileges desired in Anesthesilgy fr each facility: Privilege Descriptin Age Limitatins Anesthesilgy Cre Special Privileges Cmmunity Pediatric Privileges Anesthesilgy Cre & Advanced Pediatric Care Chrnic Pain Management Liver Transplant (Adult) TEE Basic TEE Advanced Please check () applicable age categries fr each privilege requested. Nenates & Infants (0-6 mnths) Methdist Healthcare Memphis Hspitals (MHMH) Germantwn, Le Bnheur Medical Center, Nrth, Suth & University, Outpatient Clinics & Diagnstic Facilities Infants t Children (6 ms-2) Children (2-13) Adlescents (13-18) Adlescents & Adults (13 & Abve*) Methdist Healthcare Olive Branch Hspital (MHOBH) Adults (13 & Abve*) Clinical privileges are granted nly t the extent privileges are available at each facility. Limitatins *Nte: In the case f Obstetrical cases, privileges are extended regardless f the age f the patient. 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, 4/16/14, 5/17/2017 7