Privileges for San Francisco General Hospital

Transcription

1 Requested Approved Applicant: Please initial the privileges you are requesting in the Requested column. Service Chief: Please initial the privileges you are approving in the Approved column. MedGI GASTROENTEROLOGY 2008 (0808 MEC) FOR ALL PRIVILEGES: All complication rates, including problem transfusions, deaths, unusual occurrence reports and sentinel events, as well as Department quality indicators, will be monitored semiannually CORE PRIVILEGES Admit, work-up and treat adolescent and adult patients on the Medicine Wards. Consult and manage adult patients with disorders of the stomach, intestines, esophagus, liver, gallbladder, and pancreas in the ambulatory and inpatient settings. Board of Gastroenterology or a member of the Clinical Service prior to 10/17/00. PROCTORING: Review of 5 10 cases REAPPOINTMENT: Review of 3 5 cases SPECIAL PRIVILEGES NOTE: Special privileges require Diagnostic Fluoroscopy privilege OPERATING ROOM PRIVILEGES PROCTORING: Review of 5 10 cases. REAPPOINTMENT: Review of 3 5 cases UPPER GI ENDOSCOPY Diagnostic and therapeutic (including biopsy, sclerotherapy, banding and coagulation, endoscopic clipping, and dilation) Comment [LD1]: I am not sure why this is here. If there is no valid reason the Credentialing committee can think of we would prefer to have it removed. PROCTORING: Review of 4 10 cases with previous demonstration of 150. REAPPOINTMENT: Review of 2 20 cases, and moderate sedation competency SMALL BOWEL ENDOSCOPY PROCTORING: Review of 4 cases. Printed 5/14/2014 Page 1

2 Requested Approved FLEXIBLE SIGMOIDOSCOPY PROCTORING: Review of 104 cases. REAPPOINTMENT: Review of 52 cases, and moderate sedation competency ANORECTAL AND ESOPHAGEAL MANOMETRY AND PH PROBE PROCTORING: Review of 54 cases COLONOSCOPY Diagnostic and therapeutic (including biopsy, polypectomy, coagulation and cauteryincluding BIOPSY,POLYPECTOMY, AND CAUTERY) PROCTORING: Review of 104 cases with previous demonstration of 300. REAPPOINTMENT: Review of 202 cases, and moderate sedation competency LIVER BIOPSY, PERCUTANEOUS PROCTORING: Review of 4 cases PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PROCTORING: Review of 54 cases PNEUMATIC BALLOON DILATION OF ESOPHAGUS PROCTORING: Review of 54 cases. Printed 5/14/2014 Page 2

3 Requested Approved ENDOSCOPOIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCTORING: Review of 104 cases with previous demonstration of 300. REAPPOINTMENT: Review of 2 3 cases, and moderate sedation competency ENDOSCOPIC ULTRASOUND (ESOPHAGEAL,GASTRIC, PANCREATIC AND RECTAL) Diagnostic and therapeutic (including fine needle aspiration) PROCTORING: Review of 4 10 cases with previous demonstration of 150. REAPPOINTMENT: Review of 52 cases, and moderate sedation competency SINGLE OR DOUBLE BALLOON ENTEROSCOPY (ANTEROGRADE, RETROGRADE) PROCTORING: Review of 5 cases ESOPHAGEAL CAUTERIZATION PROCTORING: Review of 4 cases ESOPHAGEAL SUTURING PROCTORING: Review of 4 cases CAPSULE ENDOSCOPY PROCTORING: Review of 104 cases with previous demonstration of 50. REAPPOINTMENT: Review of 102 cases, and moderate sedation competency WIRELESS PH PROBE

4 PROCTORING: Review of 104 cases. REAPPOINTMENT: Review of 52 cases, and moderate sedation competency. Printed 5/14/2014 Page 3

5 Requested Approved INTRALUMINAL STENT PLACEMENT PROCTORING: Review of 104 cases DIAGNOSTIC RADIOLOGY: FLUOROSCOPY PREREQUISITES: Currently Board Admissible, Board Certified, or Re-Certified in Gastroenterology or a member of the Clinical Service prior to 10/17/00. Current X- Ray/Fluoroscopy Certificate. PROCTORING: Presentation of valid California Fluoroscopy certificate; REAPPOINTMENT: Presentation of valid California Fluoroscopy certificate PROCEDURAL SEDATION PREREQUISITES: The physician must possess the appropriate residency or clinical experience (read Hospital Policy 19.8 SEDATION) and have completed the procedural sedation test as evidenced by a satisfactory score on the examination. Currently Board Admissible, Board Certified, or Re-Certified by the American Board of Gastroenterology or a member of the Clinical Service prior to 10/17/00, and has completed at least one of the following: Currently Board Admissible, Board Certified, or Re-Certified by the American Board of Emergency Medicine or Anesthesia or, Management of 10 airways via BVM or ETT per year in the preceding 2 years or, Current Basic Life Support (BLS) certification (age appropriate) by the American Heart Association PROCTORING: Review of 5 cases (completed training within the last 5 years) REAPPOINTMENT: Completion of the procedural sedation test as evidenced by a satisfactory score on the examination, and has completed at least one of the following: Currently Board Admissible, Board Certified, or Re-Certified by the American Board of Emergency Medicine or Anesthesia or, Management of 10 airways via BVM or ETT per year for the preceding 2 years or, Current Basic Life Support (BLS) certification (age appropriate) by the American Heart Association LUMBAR PUNCTURE PREREQUISITES: Currently Board Admissible, Certified, or Re-Certified by the American Board of Internal Medicine, or an Internal Medicine Subspecialty or a member of the Service prior to 10/17/00. PROCTORING: Review of 2 cases. One of which may be performed on a simulated model. REAPPOINTMENT: Review of 2 cases. One of which may be performed on a simulated model THORACENTESIS PREREQUISITES: Currently Board Admissible, Certified, or Re-Certified by the American Board of Internal Medicine, or an Internal Medicine Subspecialty or a member of the Service prior to 10/17/00. PROCTORING: Review of 2 cases. One of which may be performed on a simulated model.

6 REAPPOINTMENT: Review of 2 cases. One of which may be performed on a simulated model. Printed 5/14/2014 Page 4

7 Requested Approved PARACENTESIS PREREQUISITES: Currently Board Admissible, Certified, or Re-Certified by the American Board of Internal Medicine, or an Internal Medicine Subspecialty or a member of the Service prior to 10/17/00. PROCTORING: Review of 2 cases. One of which may be performed on a simulated model. REAPPOINTMENT: Review of 2 cases. One of which may be performed on a simulated model CENTRAL VENOUS LINE PLACEMENT PREREQUISITES: Currently Board Admissible, Certified, or Re-Certified by the American Board of Internal Medicine, or an Internal Medicine Subspecialty or a member of the Service prior to 10/17/00. PROCTORING: Review of 2 cases. One of which may be performed on a simulated model. Formatted: Space Before: 2.15 pt REAPPOINTMENT: Review of 2 cases. One of which may be performed on a simulated model WAIVED TESTING Privileges in this category relate to common tests that do not involve an instrument and are typically performed by providers at the bedside or point of care. By obtaining and maintaining waived testing privileges, providers satisfy competency expectations for waived testing by The Joint Commission. PREREQUISITES: Currently Board Admissible, Board Certified, or Re-Certified by an American Board in Emergency Medicine, Family Community Medicine, Medicine, Pediatrics, Obstetrics/Gynecology, or General Surgery. PROCTORING: By the Chief of the Laboratory Medicine Service or designee until successful completion of a web-based competency assessment tool is documented for each requested waived testing privilege. REAPPOINTMENT: Renewal of privileges requires every two years documentation of successful completion of a web-based competency assessment tool for each waived testing privilege for which renewal is requested. A. Fecal Occult Blood Testing (Hemoccult ) B. Vaginal ph Testing (ph Paper) C. Urine Chemistrip Testing D. Urine Pregnancy Test (SP Brand Rapid Test) CTSI (Clinical and Translational Science Institute) - CLINICAL RESEARCH Admit and follow adult patients for the purpose of clinical investigation in the inpatient and ambulatory UCSF CTSI Clinical Research Center settings. PREREQUISITES: Currently Board Admissible, Certified, or Re-Certified by one of the boards of the American Board of Medical Specialties, or a member of the Medical Staff prior to 10/17/00. Approval of the provider s Service Chief and Director of CTSI is required if Board Admissible, Certified, or Re-Certified in a specialty other than Internal Medicine or one of its subspecialties PROCTORING: Review of 3 cases REAPPOINTMENT: Review of 3 cases.

8 Printed 5/14/2014 Page 5

9 Requested Approved I hereby request clinical privileges as indicated above. Applicant date FOR DEPARTMENTAL USE: Proctors have been assigned for the newly granted privileges. Proctoring requirements have been satisfied. Medications requiring DEA certification may be prescribed by this provider. Medications requiring DEA certification will not be prescribed by this provider. CPR certification is required. CPR certification is not required. APPROVED BY: Division Chief date Service Chief date Printed 5/14/2014 Page 6