ST. DOMINIC HOSPITAL CARDIOLOGY SERVICE

Transcription

1 ST. DOMINIC HOSPITAL CARDIOLOGY SERVICE CREDENTIALS GUIDELINES Approved by Credentials Committee: September 2008 Revised by Credentials Committee: December 2008 Revised by Credentials Committee: August 2009 Revised by Credentials Committee: February 2010 Revised by Credentials Committee: April 2012 Revised by Credentials Committee: June 2015 Applicant: Check off the box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Other Requirements Note that privileges granted may only be exercised at the site(s) and/or setting(s) that have the appropriate equipment, license, beds, staff and other support required to provide the services defined in this document. Sitespecific services may be defined in hospital and/or department policy. This document is focused on defining qualifications related to competency to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet. BOARD CERTIFICATION: The applicant must meet the Medical Staff Bylaws requirements for board certification. Qualifications for Cardiovascular Disease (Cardiology) To be eligible to apply for core privileges in cardiovascular disease (cardiology), the initial applicant must meet the following criteria: Successful completion of an Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) accredited fellowship in cardiovascular disease. AND/OR Current certification or active participation in the examination process leading to subspecialty certification in cardiovascular disease by the American Board of Internal Medicine or the American Osteopathic Board of Internal Medicine with Special Qualifications in Cardiology as required by the Medical Staff Bylaws. Required Previous Experience: Applicants for initial appointment must be able to demonstrate active cardiology practice for the past 10 years, reflective of the scope of privileges requested, and for at least 50 patients in the past 12 months in an accredited hospital or healthcare facility or demonstrate successful completion of an ACGME or AOA accredited residency, clinical fellowship, or research in a clinical setting within the past 12 months. Reappointment Requirements: To be eligible to renew core privileges in cardiovascular disease (Cardiology), the applicant must meet the following maintenance of privilege criteria: Current demonstrated competence and an adequate volume of experience (patients) with acceptable results, reflective of the scope of privileges requested, for the past 24 months based on results of ongoing professional practice evaluation and outcomes. Evidence of current ability to perform privileges requested is required of all applicants for renewal of privileges. Qualifications for Invasive Cardiology To be eligible to apply for core privileges in invasive cardiology, the initial applicant must be granted core privileges in cardiovascular medicine and meet the following criteria: Required Previous Experience: Applicants for initial appointment must have demonstrated successful performance, reflective of the scope of privilege requested, of at least 75 diagnostic right and/or left cardiac catheterizations in the past 12 months or demonstrate successful completion of an ACGME or AOA accredited training program which included training in invasive cardiology within the past 12 months. Reappointment Requirements: To be eligible to renew core privileges in invasive cardiology, the applicant must meet the following maintenance of privilege criteria: Current demonstrated competence and an adequate volume of experience (150 diagnostic cardiac catheterizations) with acceptable results, reflective of the scope of privileges requested for the past 24 months based on results of ongoing professional practice evaluation and outcomes. Evidence of current ability to perform privileges requested is required of all applicants for renewal of privileges.

2 Qualifications for Peripheral Vascular Interventions Cardiology To be eligible to apply for core privileges in interventional cardiology, the initial applicant must be granted core privileges in cardiovascular medicine and meet the following criteria: Required Previous Experience: Successful completion of an accredited residency or fellowship in one of the following specialties: general surgery, followed by accredited fellowship in vascular surgery and leading to special certification; radiology, followed by an accredited fellowship in interventional radiology; cardiology, meeting requirements of the American Board of Internal Medicine (ABIM); or vascular medicine, meeting the requirements of the ABIM. Note: A full twelve (12) months of experience in the vascular laboratory during the fellowship year (s) is required. The experience must include the performance of at least 100 diagnostic peripheral angiographic studies during the last 24 months (50 of those of the primary operator). Alternate Training Pathway and/or Apprenticeship Pathway Documented successful completion of ACGME-approved Fellowship in Cardiovascular Medicine or Vascular Surgery or Cardiothoracic Surgery or Residency in Diagnostic Radiology; documented successful performance of 100 diagnostic peripheral angiograms and 50 peripheral vascular interventions (for at least 25 of these procedures the applicant must be primary operator), and performance of at least 5 percutaneous peripheral arterial thrombolysis cases (all procedures must be directly supervised by a physician who has already satisfied one of the credentialing pathways); completion of at least 20 Category 1 CME hours in a didactic setting of peripheral angiography and non-coronary endovascular interventions. Reappointment Requirements: Satisfactory performance of at least 25 peripheral vascular interventions cases annually (at least 50 every two years).

3 Qualifications for Electrophysiology To be eligible to apply for core privileges in cardiac electrophysiology, the initial applicant must be granted core privileges in cardiovascular medicine and meet the following criteria: Required Previous Experience: Applicants for initial appointment must have demonstrated successful performance, completion of at least one (1) additional year of training in cardiac electrophysiology beyond a standard cardiology fellowship at a certified (ACGME) training program; and meet current requirements to sit for the ABIM clinical cardiac electrophysiology exam; and The Heart Rhythm Society recommends that physicians in training who incorporate CIED implantation and follow-up into their clinical practice meet the training requirements described in the COCATS 3: Task Force 6 document and pass the American Board of Internal Medicine (ABIM) examination for Clinical Cardiac Electrophysiology (CCEP). The Society strongly agrees with the curriculum minimum one year in specialized accredited CIED training. Fellows who meet COCATS level 3 requirements for implantation of CIEDs, but have not performed ablation procedures would not qualify for the ABIM CCEP examination; however, as indicated in the Task Force 6 document, they would qualify for the examination offered by the Internal Board of Heart Rhythm Examiners (IBHRE). The physician already in practice, who decides to implant CIEDs, should undergo appropriate training in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Physicians who intend to implant ICD and CRT devices should have extensive experience with pacemaker implantation. The Heart Rhythm Society recommends that physicians meet the same training level 3 requirements specified in the COCATS 3: Task Force 6 curriculum. Furthermore, as indicated in the curriculum, the Society recommends that each physician complete an examination of competency. The examination offered by IBHRE is an appropriate alternative for practicing physicians who do not qualify for the CCEP examination offered by the ABIM. Exposure and hands on insertion, management and follow-up of a minimum of 10 temporary pacemakers; perform at least 10 elective cardioversions, and a minimum of 100 CED follow-up visits to acquire proficiency in complex arrhythmias electrocardiography, interrogation and programming of complex pacemakers; Be the primary operator (under direct supervision) of 75 CIED initial primary implantations (25 single-chamber, 25 dual-chamber, 25 CRT) of either pacing or defibrillation devices; Complete 30 CIED revisions/replacements (to include at least 10 ICD revisions as the primary operator); Participate in the follow-up of 200 CIED (100 ICD and 100 pacemaker) patient visits and acquire proficiency in interrogation and programming; Successfully pass the IBHRE Certification Examination for Competency in Cardiac Rhythm Device Therapy for the Physician ( within the previous ten years; Attend a minimum of 30 hours of formal CME education every two years to remain abreast of changes in knowledge and in technology. All training should be performed by recognized experts in the field of cardiac electrophysiology. Various resources may include peer-reviewed journals, national and local seminars, and training sessions conducted by certified teachers. Reappointment Requirements: To be eligible to renew core privileges in invasive cardiology, the applicant must meet the following maintenance of privilege criteria: Satisfactory performance of at least 100 EP studies in the past two (2) years. Criteria for special procedures: Creager, M.A et al. (2004). ACC/ACPSCAI/SVMB/SVS Clinical Competence Statement on Vascular Medicine and Catheter-Based Peripheral Vascular Interventions: A Report of the American College of Cardiology/American Heart Association/American College of Physicians Task Force on clinical Competence. Journal of the American College of Cardiology, 44 (4), American College of Cardiology/American Heart Association 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion October ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures. Heart Rhythm Society guidelines published in Heart Rhythm, Volume 4, No. 6, June 2007.

4 ST. DOMINIC HOSPITAL CARDIOLOGY SERVICE PRIVILEGE FORM Name (please print):_ Date:_ Cardiology Core Privileges Admit, evaluate, admit, diagnose, treat and provide consultation to patients of all ages presenting with disease of the heart, lungs, and blood vessels and manage complex cardiac conditions. Assess, stabilize, and determine disposition of patients with emergent conditions. The core privileges in this specialty include the procedures listed below and such other procedures that are extensions of the same techniques and skills. Cardiology Core procedures - This list is a sampling of procedures included in the core. This is not intended to be an all-encompassing list but rather reflective of the categories/types of procedures included in the core. To the applicant: If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. 1. Adult transthoracic echocardiography 2. Ambulatory electrocardiology monitor interpretation 3. Cardioversion, electrical, elective 4. ECG interpretation, including signal average ECG 5. Infusion and management of Gp IIb/IIIa agents and thrombolytic agents and antithrombolytic agents 6. Insertion and management of central venous catheters, pulmonary artery catheters, and arterial lines 7. Non-invasive hemodynamic monitoring 8. Perform history and physical exam 9. Pericardiocentesis 10. Stress echocardiography (exercise and pharmacologic stress) 11. Tilt table testing 12. Transcutaneous external pacemaker placement Invasive Cardiology Core Privileges Admit, evaluate, consult, treat patient of all ages who present with acute or chronic heart disease and who may require invasive diagnostic procedures. May provide care to patients in the intensive care setting. Assess, stabilize, and determine disposition of patients with emergent conditions. The core privileges in this specialty include the procedures listed below and such other procedures that are extensions of the same techniques and skills. Invasive Cardiology - This list is a sampling of procedures included in the core. This is not intended to be an allencompassing list but rather reflective of the categories/types of procedures included in the core. To the applicant: If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. 1. Central line placement and venous angiography 2. Coronary arteriography 3. Diagnostic right and left heart cardiac catheterization 4. Hemodynamic monitoring with balloon flotation devices 5. Insertion of intra-aortic balloon counter pulsation device 6. Placement of temporary transvenous pacemaker

5 Peripheral Vascular Interventions Core Privileges Admit, evaluate, treat and provide consultation to patients of all ages with acute and chronic coronary artery disease, acute coronary syndromes and valvular heart disease, including but not limited to chronic ischemic heart disease, acute ischemic syndromes, and valvular heart disease and technical procedures and medications to treat abnormalities that impair the function of the heart. Assess, stabilize, and determine disposition of patients with emergent conditions. The core privileges in this specialty include the procedures listed below and such other procedures that are extensions of the same techniques and skills. Peripheral Vascular Cardiology - This list is a sampling of procedures included in the core. This is not intended to be an all-encompassing list but rather reflective of the categories/types of procedures included in the core. To the applicant: If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. 1. Endomyocardial biopsy 2. Femoral, brachial or radial, axillary cannulation for diagnostic angiography or percutaneous coronary intervention 3. Interpretation of coronary arteriograms, ventriculography and hemodynamics 4. Intracoronary foreign body retrieval 5. Intracoronary infusion of pharmacological agents including thrombolytics 6. Intracoronary mechanical thrombectomy 7. Intracoronary stents 8. Intravascular Ultrasound (IVUS) of coronaries 9. Management of mechanical complications of percutaneous intervention 10. Performance of balloon angioplasty, stents, and other commonly used interventional devices 11. Use of intracoronary Doppler and flow wire 12. Use of vasoactive agents for epicardial and microvascular spasm Clinical Cardiac Electrophysiology Core Privileges Admit, evaluate, treat and provide consultation to acute and chronically ill patients of all ages, with heart rhythm disorders including the performance of invasive diagnostic and therapeutic cardiac electrophysiology procedures. Assess, stabilize, and determine disposition of patients with emergent conditions. The core privileges in this specialty include the procedures on the attached procedure list and such other procedures that are extensions of the same techniques and skills. Clinical Cardiac Electrophysiology - This list is a sampling of procedures included in the core. This is not intended to be an all-encompassing list but rather reflective of the categories/types of procedures included in the core. To the applicant: If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. 1. Insertion and management of automatic implantable cardiac defibrillators 2. Insertion of permanent pacemaker, including single/dual chamber and biventricular 3. Interpretation of activation sequence mapping recordings, invasive intracardiac electrophysiologic studies, including endocardial electrogram recording and imaging studies 4. Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment, 5. Pacemaker programming/reprogramming and interrogation 6. Performance of therapeutic catheter ablation procedures

6 Cardiology Special Requests* Moderate/Conscious Sedation Transesophageal Echocardiography (TEE) Cardiac Catheterization o Percutaneous Coronary Intervention (PCI) o Coronary Atherectomy/Thrombectomy Intra Aortic Balloon Pump Permanent Pacemaker Insertion Electrophysiology Studies / Clinical Cardiac Electrophysiology Radio Frequency Ablation Procedures (RFA) Valvuloplasty, Mitral / Aortic Ablation, Alcohol Septal Ablation, Atrial Fibrillation Cervicocerebral Angiography Carotid Stent Placement Lead Extraction I hereby make application for the privileges selected above: Signature of Applicant: Date: CRITERIA FOR SPECIAL PRIVILEGE REQUESTS MODERATE/CONSCIOUS SEDATION Appointment: Must obtain the Moderate/Conscious Sedation Packet including practice guidelines, policy, assessment test, and privilege request form. Reappointment: Will monitor cases for competency. TRANSESOPHAGEAL ECHOCARDIOGRAPHY Appointment: Successful completion of an accredited residency in cardiology and direct experience in TEE. Performance of at least 20 TEE procedures during residency; or Current privileges to interpret echocardiographs and performance of at least 20 TEE probe insertions in conjunction with a fully trained, board-admissible or board-certified gastroenterologist or another individual experienced in TEE. Reappointment: Maintain basic echo privileges. Satisfactory performance of sixteen (16) TEEs during the past two years. CARDIAC CATHETERIZATION Appointment: Successful completion of a minimum of 150 catheterizations during the past two years. Reappointment: Successful completion of a minimum of 50 catheterizations during the past two years. PERCUTANEOUS CORONARY INTERVENTION (PCI) Appointment: Successful completion of an accredited residency in cardiology, followed by: successful completion of at least twelve (12) months of fellowship training devoted to PCI; and performance of at least 150 PCIs (100 of those as the primary operator). Must have documentation of at performance of at least 500 cardiac catheterizations that include coronary angiography; and involvement in at least 150 PCIs during the past two years. Reappointment: Documentation of satisfactory performance of at least 100 PCIs during the past two years.

7 INTRA AORTIC BALLOON PUMP Appointment: Formal training in insertion with letter from the instructor or department chair verifying qualifications and successful insertion of at least five (5) devices in the past twelve (12) months; or formal training in insertion with a letter from the department chair and documentation of proctoring of three (3) successful device insertions; or letter of competency from a CV surgeons or qualified cardiologist to include documentation of successful proctoring of five (5) device insertions. Reappointment: Successful completion of at least five (5) device insertions in the past two (2) years. PACEMAKER INSERTION, PERMANENT Appointment: Successful completion of an ACGME certified training program (either surgery or cardiology); and implantation of 25 permanent pacemakers under supervision as a primary operator and 50 follow-up appointments; and documentation of satisfactory experience and outcomes by Program Director. OR If not directly out of training and currently implanting permanent pacemakers at another hospital, documentation by Physician Lab Director of satisfactory implantation and outcomes of at least twelve (12) permanent pacemakers within the preceding twelve (12) months. Reappointment: Satisfactory implantation and outcomes of twelve (25) permanent pacemakers in the past two years. RADIO FREQUENCY ABLATION PROCEDURES (RFA) Appointment: Must be privileged in Electrophysiology. Must have completed a recognized cardiac RFA training program and have been proctored successfully in five initial cases by an experienced cardiac RFA practitioner. Reappointment: Satisfactory performance of at least ten (10) RFAs in the past two (2) years. VALVULOPLASTY, MITRAL / AORTIC Appointment: Successful completion of a Board certification in Interventional Cardiology training on valvuloplasty with live demonstrations. Successful proctoring of at least ten (10) mitral valvuloplasties and five (5) aortic valvuloplasties, or documentation of at least five (5) successful mitral and aortic valvuloplasties in the past two (2) years. Reappointment: Successful completion of five (5) of each type of valvuloplasty in the past two (2) years. ALCOHOL SEPTAL ABLATION Appointment: Must have completed an ACGME/AOA-accredited residency program in cardiovascular disease, followed by completion of an accredited interventional cardiology fellowship program. If alcohol septal ablation training was not included in the fellowship program, the applicant must have completed training with an experienced alcohol septal ablation team that included proctored initial procedures; OR Must be able to demonstrate that they have performed at least twenty (20) successful alcohol septal ablation procedures. A letter of reference should come from the director of the applicant s interventional cardiology fellowship program that included alcohol septal ablation training or from the proctor of the applicant s initial alcohol septal ablation procedures. Alternately, a letter of reference regarding performance of alcohol septal ablation procedures should come from the chief of cardiology or interventional cardiology at the institution where the applicant most recently practiced. Reappointment: Successful completion of five (5) septal ablation procedures in the past two (2) years. ATRIAL FIBRILLATION ABLATION Must be granted core privileges in cardiac electrophysiology Appointment: Must have demonstrated successful performance, reflective of the scope of privilege request, of at least 75 atrial fibrillation ablations in the past 12 months or demonstrated successful completion of an ACGME or AOA accredited training program which included training in atrial fibrillation ablation within the past 12 months. Reappointment: Current demonstrated competence and an adequate volume of experience (50 atrial fibrillation ablations) with acceptable results, reflective of the scope of privileges requested for the past 24 months.

8 Evidence of current ability to perform privileges requested is required of all applicants for renewal of privileges. CERVICOCEREBRAL ANGIOGRAPHY Documented successful completion of an ACGME-approved Fellowship in Cardiovascular Medicine, Vascular Surgery, Cardiothoracic Surgery, or Residency in Diagnostic Radiology AND Successful performance during training of at least 100 diagnostic Cervicocerebral angiograms (at least 50 as primary operator) with documented acceptable indications and outcomes. Must maintain Active Peripheral Vascular Intervention Privileges followed by successful performance of at least 40 diagnostic cervicocerebral angiograms (at least 20 as primary operator) with documented acceptable indications and outcomes. CAROTID STENT PLACEMENT Documented successful completion of an ACGME-approved Fellowship in Interventional Cardiovascular Medicine, Vascular Surgery, or Cardiothoracic Surgery and supervised performance during training of at least 100 cervicocerebral angiograms (half as primary operator) and 15 complete carotid stent procedures as primary operator with acceptable indications and outcomes. Reappointment: Current demonstrated competence in an adequate volume of cases with acceptable indications and outcomes for the past 24 months or peer reference from a qualified physician who has observed the practice and will verify continued competence in the privileges requested. LEAD EXTRACTION Must be grated core privileges in cardiac electrophysiology. Appointment: Must have demonstrated successful performance, reflective of the scope of privilege, request, of at least 20 lead extraction (extraction of pacemaker/defibrillator leads) or demonstrated success completion of an ACGME or AOA accredited training program which included training in lead extraction within the past 12 months. Reappointment: Current demonstrated competence and an adequate volume of experience with acceptable results, reflective of the scope of privileges requested for the past 24 months. Note: this list is a sampling of procedures included in the core. This is not intended to be an allencompassing list but rather reflective of the categories/types of procedures included in the core. If you wish to exclude any procedures, please strike through those procedures that you do not wish to requests, initial and date. Core Procedure List: Cardiology Arterial line placement 2D echocardiography, Doppler, and color flow Cardioversion, electrical, elective EKG and rhythm interpretation Holter scanning monitor interpretation Infusion and management of Gp IIb/IIIa agents and thrombolytic agents Insertion and management of central venous catheters Insertion and management of pulmonary artery catheters Non-invasive hemodynamic monitoring Pericardiocentesis Signal Average ECG Stress echocardiography (exercise and pharmacologic stress) Tilt table testing Transcutaneous external pacemaker placement Transthoracic echocardiography Use of thrombolytics and antithrombolytic agents Perform waived laboratory testing not requiring an instrument, including but not limited to fecal

9 Invasive Cardiology Central line placement and venous angiography Coronary arteriography Diagnostic right and left heart cardiac catheterization Hemodynamic monitoring with balloon flotation devices Temporary pacemaker, transvenous, placement Insertion of intraortic balloon counter pulsation device Perform waived laboratory testing not requiring an instrument, including but not limited to fecal Interventional Cardiology Endomyocardial biopsy Femoral, brachial or radial, axillary cannulation for diagnostic angiography or percutaneous coronary intervention Interpretation of coronary arteriograms, ventriculography and hemodynamics Intracoronary foreign body retrieval Intracoronary infusion of pharmacological agents including thrombolytics Intracoronary mechanical thrombectomy Intracoronary stents Intravascular Ultrasound (IVUS) of coronaries Management of mechanical complications of percutaneous intervention Performance of balloon angioplasty, stents, and other commonly used interventional devices Use of intracoronary Doppler and flow wire Use of vasoactive agents for epicardial and microvascular spasm Perform waived laboratory testing not requiring an instrument, including but not limited to fecal Peripheral Vascular Interventions Dialysis grafts, and venous angiography Extracranial regional (arterial or venous) infusion of thrombolytic/pharmacological agents Occlusion coil or other embolization particle administration Peripheral angiography including visceral, renals, dialysis grafts, and venous angiography Peripheral vascular interventions (arterial, venous, grafts, and fistulas) Perform waived laboratory testing not requiring an instrument, including but not limited to fecal Clinical Cardiac Electrophysiology Insertion of permanent pacemaker insertion, including single/dual chamber and biventricular Interpretation of activation sequence mapping recordings, invasive intracardiac electrophysiologic studies, including endocardial electrogram recording and imaging studies Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment, Pacemaker programming/reprogramming and interrogation Insertion and management of automatic implantable cardiac defibrillators Performance of therapeutic catheter ablation procedures Perform waived laboratory testing not requiring an instrument, including but not limited to fecal