For Reference Only PEDIATRIC MEDICINE 2013

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1 Summary of Services and Availability (by location) UPMC University of Pittsburgh Medical Center Each location has sufficient space, equipment, staffing and financial resources in place or available in sufficient time as required to support each requested privilege. On an ongoing basis, the organization consistently determines the resources necessary for each requested privilege related to the facility's scope of service. Please review the following Summary of Services and Availability by Location prior to making your selections. If a facility is specifically identified below as NOT having a privilege/service available, you will NOT be considered for that privilege at that individual facility. Any request made that is identified as not available at an individual site will be considered Not Applicable for that site(s), and will be identified as such on your final approved Delineation of Privileges form. Key x means Privilege is Available at that location. C means contractual arrangement restricts granting this privilege means Privilege Not Available at that location. Facility Codes: UALT= UPMC Altoona Privilege Core privileges- General Consultation privileges Core privileges- Adolescent Medicine Core privileges- Allergy/Immunology Core privileges- Behavioral Health, Psychologist Core privileges- Behavioral Health, Neuropsychology Core privileges- Cardiology Core privileges- Child Advocacy Core privileges- Critical Care Core privileges- Dermatology Core privileges- Developmental Behavioral Pediatrics Core privileges- Emergency Medicine Core privileges- Endocrinology and Diabetes Core privileges- Gastroenterology Core privileges- Hematology/Oncology Core privileges- Infectious Disease Core privileges- Medical Genetics Core privileges- Neonatology, Well Baby Core privileges- Neonatology, Well Newborn Core privileges- Neonatology, Newborn Hospitalist Core privileges- Neonatology Core privileges- Nephrology Core privileges- Neurology Core privileges- Pulmonology Core privileges- Pediatric Sleep Medicine Core privileges- Rheumatology Core privileges- Weight Management and Wellness ADOLESCENT MEDICINE Gynecological tissue biopsies UALT

2 IUD insertion and removal Subcutaneous contraceptive implant insertion and removal Gynecologic surgery, to include laparoscopy, treatment of ovarian diseases, uterine/cervical disease, vulvar disease (to include laser of vulva), and laparotomy for gynecological problems. If patient requires admission for post-operative care, he/she must be admitted to the service of a surgeon on the Active Medical Staff. Toxicology ALLERGY/IMMUNOLOGY/INFECTIOUS DISEASE Epicutaneous, intradermal & patch skin tests Interpret methacholine and specific antigen provocation challenge tests and/or supervise, dispense and administer allergenic extracts BEHAVIORAL HEALTH Hypnotherapy CARDIOLOGY Cath/Interventional Diagnostic cardiac catheterization Interventional cardiac catheterization Placement of umbilical artery/vein catheter Endomyocardial biopsy Non-Invasive Imaging Transesophageal Echocardiogram Fetal Echocardiography Transthoracic Echocardiography (TTE) Electrophysiology Electrophysiology study Ablation (radiofrequency and cryoablation) Device and lead insertion and removal (pacemaker, defibrillator, implantable loop recorder) Miscellaneous CHILD ADVOCACY Anoscopy Colposcopy Completion of forensic rape kit Pelvic or genital exam under anesthesia Removal of foreign body from vagina and/or anus CRITICAL CARE MEDICINE Consultative services and admitting privileges for all pediatric patients admitted who require critical care Airway management, including endotracheal Central venous access (percutaneous or by cutdown) Arterial access (percutaneous or by cutdown) Pulmonary arterial catheter placement (percutaneous or by cutdown) Initiation and management of mechanical ventilation, including high frequency ventilation Page 2 of 5

3 Placement of thoracostomy tubes Placement of pericardiocentesis tubes Placement of paracentesis tubes Initiation and management of vasoactive and/or antiarrhythmic drug administration Management of patients on extracorporeal membrane oxygenation (ECMO) Management of continuous renal replacement therapy (CRRT) Management of elevated intracranial pressure Administration and management of intermittent and continuous sedation, analgesia, and intravenous anesthetics, for management of critically ill patients, as well as for procedural and deep sedation General management of single and multiple organ failures, including but not limited to shock, respiratory failure, coma, renal failure, hepatic failure, coagulopathy Management of cardiopulmonary resuscitation Command physician responsibilities for critical care transport DERMATOLOGY Anesthesia, local Biopsy Biopsy, knife surgery Cryosurgery Electrosurgery Excision of small tumors (limited to subcutaneous tissue with simple closures) Tele-dermatology EMERGENCY MEDICINE Management of Toxicology GASTROENTEROLOGY Upper Endoscopy EGD with variceal sclerotherapy or banding EGD for control of hemorrhage EGD with dilation of esophageal stricture or achalasia Endoscopy with percutaneous gastrostomy tube placement (PEG) Endoscopy with conversion of gastrostomy tube to jejunal tube Enteroscopy for control of hemorrhage (via upper endoscopy) Ileoscopy through stoma for control of Hemorrhage Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP, diagnostic ERCP, therapeutic Lower Endoscopy Colonoscopy for control of hemorrhage Therapeutic Colonoscopy Dilatation of strictures Motility and ph Probe Studies Esophageal manometry Page 3 of 5

4 Esophageal impedance Antroduodenal motility Colonic motility Anorectal manometry Miscellaneous Procedures Percutaneous liver biopsy Paracentesis GENERAL PEDIATRICS Tympanocentesis HEMATOLOGY/ONCOLOGY Percutaneous Biopsy Bone Marrow Skin Aspiration Bone Marrow Thoracentesis Paracentesis Joint Catheterization Percutaneous Arterial Line Placement Percutaneous Catheterization of Veins Miscellaneous Procedures Bone Marrow Harvesting Bone Marrow Transplantation Lumbar Puncture Administer IT Chemotherapy Ordering of Exchange Transfusion Order/monitor Chemotherapy PCA Management MEDICAL GENETICS Gene therapy for management of an inborn error of metabolism Skin biopsy NEONATOLOGY Management of patients on extracorporeal membrane oxygenation (ECMO) Management of Continuous Renal Replacement Therapy NEPHROLOGY Percutaneous renal biopsy Bladder catheterization NEUROLOGY Page 4 of 5

5 Electromyography, perform Performing Ultrasound based Transcranial Doppler Monitoring Botox Injection Needle Muscle Biopsy PULMONOLOGY Bronchoscopy Bronchoalveolar Lavage Bronchial Biopsy Transbronchial Biopsy Polysomnogram interpretation Pulmonary Function Testing and Interpretation with sedation Pulmonary Function Testing and Interpretation w/o sedation Interpret methacholine and specific antigen provocation challenge tests and/or supervise, dispense and administer allergenic extracts Exercise testing RHEUMATOLOGY Diagnostic and therapeutic arthrocentesis TELEMEDICINE Page 5 of 5 Revised: 3/18/15

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