Practice area 191 CLINICAL PRIVILEGE WHITE PAPER Cardiovascular technologist Background Cardiovascular technologists are allied health professionals who are concerned with the diagnosis and treatment of patients with cardiac and peripheral vascular disease. They are qualified by specific technological education to perform various cardiovascular/peripheral vascular diagnostic and therapeutic procedures. The role of the cardiovascular technologist may include, but is not limited to, the following: Reviewing/recording pertinent patient history and supporting clinical data Performing appropriate procedures and obtaining a record of anatomical, pathological, and/or physiological data for interpretation by a physician Exercising discretion and judgment in the performance of cardiovascular diagnostic and therapeutic services Cardiovascular technologists perform diagnostic and therapeutic examinations at the request or direction of a physician in the following three basic areas: invasive cardiology, noninvasive cardiology, and noninvasive peripheral vascular study. The invasive cardiovascular technologist is responsible for performing examinations under the direction of a physician in the cardiac catheterization lab. The noninvasive cardiovascular technologist obtains recordings of ultrasound images of the heart and related structures for the physician to interpret. The noninvasive peripheral vascular technologist performs noninvasive peripheral testing to evaluate the hemodynamics of patients arterial, venous and/or cerebrovascular circulation using Doppler ultrasound, plethysmography, duplex imaging, and sound spectrum. Due to current and upcoming reimbursement legislation, cardiovascular technologists have a need for appropriate credentials. Graduates from the programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) are eligible to obtain professional certification through Cardiovascular Credentialing International (CCI) in cardiac catheterization, echocardiography, vascular ultrasound, and cardiographic techniques. Cardiac sonographers and vascular technologists may also obtain certification from the American Registry of Diagnostic Medical Sonographers. A supplement to Briefings on Credentialing 781/639-1872 05/03 1
Positions of societies and academies SICP The Society of Invasive Cardiovascular Professionals (SICP) publishes the position statement Entry of Health Professionals Who Practice In the Cardiac Catheterization Laboratory. In this statement, the SICP recommends the following credentialing criteria: The minimal preparation for entry into professional practice in the cardiac catheterization laboratory (CCL) should be the Registered Cardiovascular Technologist (RCVT).* Registered nurses, radiologic technologists, respiratory therapists, and all other credentials not currently holding the RCVT credential should obtain the RCVT within two years of full-time employment in the CCL. In addition, it is preferable that individuals holding credentials other than the RCVT have at least one year of experience in a criticalcare setting or in performing similar procedures (i.e., special radiologic procedures). *The RCVT credential above is now identified as the RCIS (Registered Cardiovascular Invasive Specialist), RCS (Registered Cardiac Sonographer) and the RVS (Registered Vascular Specialist). These credentials are awarded by CCI. Positions of other interested parties CCI CCI administers credentialing examinations for cardiovascular technologists as an independent credentialing agency. There is a two-part examination process that is available for CCI registry examinations. Registry credentials are awarded to those applicants who successfully complete the Cardiovascular Science exam and one of the registry examinations in invasive, noninvasive, or vascular technology. Successful applicants are awarded one of the following credentials: RCIS RCS RVS CCI requires that applicants for the registry examinations must show that they have one of the following qualifications: Two years in the field (full-time teaching, researching, providing, managing, and supervising patient care and diagnosis in cardiovascular medicine) 2 A supplement to Briefings on Credentialing 781/639-1872 05/03
An associate s degree or equivalent college hours in health, science, natural science, nursing, engineering, or any other primary science program and one year in the field Graduation from an accredited cardiovascular or diagnostic medical sonography program in the specialty for which the examination is requested A baccalaureate degree in science or a health-related field, and six months in the field Graduation from a nonaccredited cardiovascular or sonography program or a program accredited through an agency other than CAAHEP that has a minimum of one year of specialty training and a minimum of 800 clinical hours in the specialty for which examination is requested CIC also administers a one-part certification examination for ECG (electrocardiogram), cardiac stress testing, and Holter monitors. Successful completion of the certified cardiographic exam awards the Certified Cardiographic Technician (CCT) credential. CAAHEP The CAAHEP currently accredits educational programs in the allied health discipline of cardiovascular technology. The programs can encompass one or more of the basic areas of expertise: invasive cardiology, noninvasive cardiology, or noninvasive peripheral vascular study. Applicants for accreditation must specify the area or areas of specialization for which accreditation is being sought. Accreditation in one area does not imply accreditation in other areas. In regard to the length of the course of study for accredited educational programs, the CAAHEP states the following: For the high school graduate without previous postsecondary education, the course of study shall normally span a period of 24 months and consist of one year of core courses followed by a year of instruction for each area of specialization. For the individual previously qualified in a clinically related allied health profession and meeting the core curriculum course requirements, the professional curriculum shall normally be one calendar year in length for each area of specialization. These programs shall be conducted within a hospital environment or in a combination of academic and clinical settings. A supplement to Briefings on Credentialing 781/639-1872 05/03 3
JCAHO The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has no formal position on the delineation of privileges for cardiovascular technologists. However, in regard to qualifications for cardiovascular technologists, hospitals must comply with the following human resources (HR) standards from the 2003 Comprehensive Accreditation Manual for Hospitals: HR.1 The hospital leaders define the qualifications and performance expectations for all positions HR.2 The hospital provides an adequate number of staff members whose qualifications are consistent with job responsibilities HR.4 An orientation process provides initial job training and information and assesses the staff s ability to fulfill specified responsibilities HR.4.2 Ongoing inservice and other education and training maintain and improve staff competence and support an interdisciplinary approach to patient care HR.5 The hospital assesses each staff member s ability to meet the performance expectations stated in his or her job description CRC draft criteria An organization should not wait until it receives a request for an application for clinical privileges from a cardiovascular technologist to consider whether it wishes to grant privileges to this type of practitioner. The policy governing cardiovascular technologists should be drafted ahead of time by the organization and should consider the needs of the community and medical staff, and the hospital s mission and strategic plan. In addition, the organization should review federal laws, state laws, and state and local licensing requirements. Criteria should be in place covering qualifications, scope of practice, and physician supervisory requirements. The criteria and process for granting privileges to cardiovascular technologists should be outlined in an appropriate document. The following draft criteria are intended to serve solely as a starting point for the development of an institution s policy regarding this practice area. Minimum threshold criteria for requesting core privileges for cardiovascular technologists Basic education and minimum formal training: Applicants must have completed an accredited-training program in the specialty of cardiovascular technology for which privileges are 4 A supplement to Briefings on Credentialing 781/639-1872 05/03
requested or can document equivalent practice experience. Applicants should also be certified in the specialty of cardiovascular technology for which privileges are requested. Required previous experience: Applicants must be able to demonstrate that they have provided inpatient cardiovascular technology services for at least 50 patients in the past 12 months. Note: A letter of reference should come from the director of the applicant s cardiovascular technology training program. Alternatively, a letter of reference regarding competence should come from the applicant s cardiovascular technology supervisor at the institution where the applicant most recently practiced. Core privileges for cardiovascular technologists Core privileges for the basic areas of cardiovascular technologist expertise include but are not limited to the following: Invasive cardiology Reviewing and recording patient history and supporting clinical data Performing diagnostic and therapeutic examinations Performing diagnostic and therapeutic services Collecting and preparing diagnostic test data for review by a physician Recording selective vessel and heart chamber pressure Performing cardiac output studies Preparing, calibrating, and operating monitoring instrumentation utilized for determining the presence and extent of cardiovascular abnormalities in diagnostic laboratory or operating room settings Noninvasive cardiology Recording of data and performing preliminary analysis of noninvasive cardiovascular data in modalities such as echocardiography/sonography electrocardiography exercise stress test Noninvasive peripheral vascular study Recording of data and performing preliminary analysis of noninvasive peripheral vascular data in studies such as vascular ultrasound Doppler ultrasound thermography plethysmography A supplement to Briefings on Credentialing 781/639-1872 05/03 5
Reappointment Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided inpatient cardiovascular technology services for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to cardiovascular technology should be required. For more information For more information regarding this practice area, contact: Cardiovascular Credentialing International Thalia Landing Offices, Building 2 4356 Bonney Road, Suite 103 Virginia Beach, VA 23452 Telephone: 800/326-0268 Fax: 757/497-3491 Web site: www.cci-online.org Commission on Accreditation of Allied Health Education Programs 35 East Wacker Drive, Suite 1970 Chicago, IL 60601-2208 Telephone: 312/553-9355 Fax: 312/553-9616 Web site: www.caahep.org Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL 60181 Telephone: 630/792-5000 Fax: 630/792-5005 Web site: www.jcaho.org Society of Invasive Cardiovascular Professionals P.O. Box 61606 Virginia Beach, VA 23466 Telephone: 757/497-3694 Fax: 757/497-0010 Web site: www.sicp.com 6 A supplement to Briefings on Credentialing 781/639-1872 05/03
Privilege request form Cardiovascular technologist In order to be eligible to request clinical privileges as a cardiovascular technologist, an applicant must meet the following minimum threshold criteria: Basic education and minimum formal training: Applicants must have completed an accredited training program in the specialty of cardiovascular technology for which privileges are requested or can document equivalent practice experience. Applicants should also be certified in the specialty of cardiovascular technology for which privileges are requested. Required previous experience: Applicants must be able to demonstrate that they have provided inpatient cardiovascular technology services for at least 50 patients in the past 12 months. References: A letter of reference should come from the director of the applicant s cardiovascular technology training program. Alternatively, a letter of reference regarding competence should come from the applicant s cardiovascular technology supervisor at the institution where the applicant most recently practiced. Core privileges: Core privileges for the basic areas of cardiovascular technologist expertise include but are not limited to the following: Invasive cardiology - Reviewing and recording patient history and supporting clinical data - Performing diagnostic and therapeutic examinations - Performing diagnostic and therapeutic services - Collecting and preparing diagnostic test data for review by a physician - Recording selective vessel and heart chamber pressure - Performing cardiac output studies - Preparing, calibrating, and operating monitoring instrumentation utilized for determining the presence and extent of cardiovascular abnormalities in diagnostic laboratory or operating room settings Noninvasive cardiology Recording of data and performing preliminary analysis of noninvasive cardiovascular data in modalities such as - echocardiography/sonography - electrocardiography - exercise stress test Noninvasive peripheral vascular study Recording of data and performing preliminary analysis of noninvasive peripheral vascular data in studies such as - vascular ultrasound - Doppler ultrasound - thermography - plethysmography Reappointment: Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided inpatient cardiovascular technology services for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to cardiovascular technology should be required. I understand that by making this request I am bound by the applicable bylaws or policies of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this request. Applicant s signature: Typed or printed name: Date: A supplement to Briefings on Credentialing 781/639-1872 05/03 7
Clinical Privilege White Papers Advisory Board James F. Callahan, DPA Executive vice president and CEO American Society of Addiction Medicine Chevy Chase, MD Sharon Fujikawa, PhD Clinical professor, Dept. of Neurology University of California, Irvine Medical Center Orange, CA John N. Kabalin, MD, FACS Urologist/Laser surgeon Scottsbluff Urology Associates Scottsbluff, NE Publisher/Vice President: Suzanne Perney sperney@hcpro.com Executive Editor: Dale Seamans dseamans@hcpro.com John E. Krettek Jr., MD, PhD Neurological surgeon Vice president for medical affairs Missouri Baptist Medical Center St. Louis, MO Michael R. Milner, MMS, PA-C Senior physician assistant consultant Phoenix Indian Medical Center Phoenix, AZ Beverly Pybus President The Beverly Group Georgetown, MA Managing Editor: Edwin B. Niemeyer eniemeyer@attbi.com Richard Sheff, MD Vice president of consulting and education The Greeley Company, a division of HCPro, Inc. Marblehead, MA The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2003 HCPro, Inc., Marblehead, MA 01945. 8 A supplement to Briefings on Credentialing 781/639-1872 05/03