PODIATRY Delineation of Clinical Privileges

Transcription

1 PODIATRY Delineatin f Clinical Privileges Criteria fr granting privileges: Pdiatry Cre I - Current bard certificatin by the American Bard f Pdiatric Medicine (ABPM). Or Successful cmpletin f a Cuncil n Pdiatric Medical Educatin (CPME)-apprved 24 mnth pdiatric medical residency and ABPM bard certificatin within 5 years f prgram cmpletin. Pdiatry Cre II Surgery f Freft and Midft Successful cmpletin f a 24 mnth CPME-apprved pdiatric surgical residency and Current bard certificatin in Ft Surgery by the American Bard f Ft and Ankle Surgery (ABFAS) Or Successful cmpletin f a 24 mnth CPME-apprved pdiatric surgical residency and ABFAS Ft Surgery bard certificatin within 5 years f prgram cmpletin. Pdiatry Cre III - Surgery f Rearft and Ankle - Successful cmpletin f a 24 mnth CPME apprved pdiatric surgical residency and Current ABFAS bard certificatin in Ft Surgery (prerequisite) and in Recnstructive Rearft/Ankle Surgery 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 Bard apprved: March, 2011, Revised 4/16/14, 7/19/17 1

2 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. 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 Practitiners 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 4/16/14, 7/19/17 2

3 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 Pdiatry Cre I Current bard certificatin by the American Bard f Pdiatric Medicine (ABPM). Or Successful cmpletin f a 24 mnth pdiatric medical residency training prgram and APBM bard certificatin within 5 years f prgram cmpletin. All pst-graduate training must be apprved by the CPME. If applying directly ut f training r in less than 24 mnths after training cmpletin: Case lg f at least 50 cases validated by Training Directr And Training Directr recmmendatin. If ut f training greater than 24 mnths: Case lg dcumenting management f at least 50 pdiatric patients within the previus 24 mnths. First five cases. Case lg dcumenting treatment f 50 pdiatric patients within the previus 24 mnths. 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 privilege. Curtesy members shuld supply case lgs frm ther facilities HIM departments t meet the minimum requirement(s) t be cnsidered fr the privilege. 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. Department chair recmmendatin will be btained frm primary practice facility. Bard apprved: March, 2011, Revised 4/16/14, 7/19/17 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 Pdiatry Cre II Surgery f Freft and Midft Pdiatry Cre III - Surgery f Rearft and Ankle Successful cmpletin f a 24 mnth CPME-apprved pdiatric surgical residency and Current bard certificatin in Ft Surgery by the American Bard f Ft and Ankle Surgery (ABFAS) Or Successful cmpletin f a 24 mnth CPME-apprved pdiatric surgical residency and Ft Surgery bard certificatin within 5 years f prgram cmpletin. Successful cmpletin f a 24 mnth CPME-apprved pdiatric surgical residency and Current ABFAS bard certificatin in Ft Surgery (prerequisite) and in Recnstructive Rearft/Ankle Surgery. If applying directly ut f training r in less than 24 mnths after training cmpletin: Case lg f at least 50 freft and midft prcedures validated by the Training Directr And Training Directr recmmendatin. If ut f Training Greater than 24 mnths: Case lg dcumenting at least 50 freft and midft prcedures perfrmed within the previus 24 mnths. If applying in 24 mnths r less after training cmpletin: Case lg f at least 50 recnstructive rearft/ankle prcedures validated by the Training Directr And Training Directr recmmendatin. First 5 cases t include at least ne buninectmy with tendn transfer and ne midft prcedure frm the prcedures specific t this class f privileges First 5 cases - t include at least ne rearft/ankle arthrdesis and ne arthrereisis - frm the prcedures specific t this class f privileges Case lg dcumenting at least 50 freft and midft prcedures perfrmed within the previus 24 mnths. Case lg dcumenting at least 50 recnstructive rearft/ankle prcedures perfrmed within the previus 24 mnths. Arthrplasty with r withut Prsthesis Current ABFAS bard certificatin in Ft Surgery (prerequisite) and in Recnstructive Rearft/Ankle Surgery. If ut f Training greater than 24 mnths: Case lg dcumenting at least 50 recnstructive rearft/ankle prcedures perfrmed within the previus 24 mnths. Case lg dcumenting 5 prcedures within the previus 24 mnths. First 3 cases Case lg dcumenting at least 5 prcedures within the previus 24 mnths. Achilles Tendn Repair Current ABFAS bard certificatin in Ft Surgery (prerequisite) and in Recnstructive Rearft/Ankle Surgery. Case lg dcumenting 5 prcedures within the previus 24 mnths. First 3 cases Case lg dcumenting at least prcedures within the previus 24 mnths. Bard apprved: March, 2011, Revised 4/16/14, 7/19/17 4

5 Admissin f a patient fr pdiatric services shall be the respnsibility f a member f the Medical Staff with admitting privileges. The patient shall receive the same basic medical appraisal as patients admitted fr ther services, and shall be the cmbined respnsibility f the admitting physician member and pdiatrist. Pre-p clearance shall be cmpleted prir t admissin. The pdiatrist s respnsibilities include: Pdiatric histry Recrd f pdiatric examinatin Pre-perative diagnsis Operative reprt describing the findings and perative prcedure. Any tissue remved shall be submitted fr pathlgical examinatin. Prgress ntes related t pdiatric care Summary f hspital curse and pst-hspitalizatin plan f care The admitting physician s respnsibilities include: General medical histry Physical examinatin with emphasis n the general medical cnditin f the patient and suitability fr anesthesia and surgery General medical care during hspitalizatin Discharge rder Discharge summary Inpatient cnsultatins may be answered by a pdiatrist, and, if apprpriate, the requesting physician will assume the respnsibilities utlined abve. Pdiatry Cre I Privileges: Privileges include evaluatin, diagnsis, and prvisin f nn-surgical care t patients with injuries and disrders f the ft and ankle including sft tissues belw the tibial tubersity. Pdiatrists shall nt be the primary physician fr the management f medical prblems. Privileges include: Bandaging f ft Trimming f tenails Massaging f feet. Pdiatry Cre II Surgery f Freft and Midft: Privileges include evaluatin, diagnsis and treatment f pdiatric patients requiring freft and midft prcedures. Privileges include: Avulsin f Nail-plate (partial r cmplete) Arthrdesis, Interphalangeal Jints with Fixatin Incisin and Drainage (I&D) f Superficial Abscess Debridement f Ft Ulcer Remval f Superficial Freign Bdy f Digit r Freft Bard apprved: March, 2011, Revised 4/16/14, 7/19/17 5

6 Tendn Lengthening f Metatarsal Phalangeal Jint Capsultmy, Interphalangeal Jint Excisin r Bipsy f Sft Tissue Lesins Excisin f Lesins f Tendn Sheath, Capsule Cyst, r Ganglin Phalangectmy (partial r cmplete) Excisin f Exstasis Ostetmy f Phalanx Excisin f Interphalangeal Sesamid Open and Clsed Reductin f Digital Fracture Metatarsal Head Resectin, Partial r Cmplete (plantar lesins/ulcers) Ostetmy f Lesser Metatarsal, with r withut Internal/External Fixatin (plantar lesins/ulcers) Ostetmy f First Metatarsal, with r withut Internal/External Fixatin (bunins) Excisin f Accessry Bnes Fifth Metatarsal Head Resectin, Partial r Cmplete (tailr s bunin) Arthrtmy and Capsultmy Freft (jint cleanuts) Open r Clsed Reductin Metatarsal Fracture Excisin f Ganglin f Freft, Intermetatarsal Neurma, Perineurfibrsis f Freft Crrectin f Hallux Valgus and Hallux Varus Buninectmy with Ostetmy Buninectmy with Tendn Transfer, with r withut Ostetmy Repair Syndactyly Repair Plydactyly Midft Prcedures Distal t, but nt including, the Transverse Tarsal Jint: Midft Arthrdesis, Exstectmy Midtarsal Bne Open and Clsed Reductin f Lisfanc Jint Fracture Ostetmy/Resectin f Tarsal bne Ostemyelitis Management - Freft Pdiatry Cre III - Surgery f Rearft and Ankle: Privileges include evaluatin, diagnsis and treatment f pdiatric patients requiring rearft and ankle prcedures. Privileges include: Ligmentplastic Repair r Ankle Stabilizatin Arthrereisis with Implants, Rearft and Ankle Majr Rearft Arthrdesis Triple, Subtalar Bard apprved: March, 2011, Revised 4/16/14, 7/19/17 6

7 Fractures f the Rearft Tarsals, ORIF r Clsed Reductin Ankle fractures ORIF r Clsed Reductin r external fixatin NO higher than the distal tibial metaphyseal flare - NOT including Piln fractures Ankle Arthrdesis Ostemyelitis management Rearft and Ankle Flap/skin Grafts Plastic Repair f Rearft skin I&D, Debridement f Ft/Ankle Infectins Neurlysis and Neurectmy f the Ankle Excisin f Sft Tissue Neplasms f the Ankle Clubft and Vertical Talus Release/Recnstructin Rearft and Ankle Ostetmies and Cartilage Repair Bne Graft Harvest Rearft r Distal Medial Mallelus Excisin f Malignant Neplasms f the Ft and Ankle Ostetmy f the Ankle, t extend NO higher than the distal tibial metaphyseal flare Special privileges: 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. Bard apprved: March, 2011, Revised 4/16/14, 7/19/17 7

8 Pdiatry Clinical Privileges Check belw the particular privileges desired in Pdiatry fr each facility: Privilege Descriptin Age Limitatins Pdiatry Cre I Please check () applicable age categries fr each privilege requested. Methdist Healthcare Memphis Hspitals (MHMH) Methdist Healthcare Olive Branch Hspital Germantwn, Le Bnheur Children s Hspital, (MHOBH) Nrth, Suth & University, Outpatient Clinics & Diagnstic Facilities * Nenates (0-28 days) Infants (29 days 2 Years) Children & Adlescents (2-18 years) Adults & Adlescents (13-& Abve) Children & Adlescents (2-18 years) Adults & Adlescents (13 & abve) Pdiatry Cre II Surgery f Freft and Midft Pdiatry Cre III - Surgery f Rearft and Ankle Pdiatry Cre III special Privileges Achilles Tendn Repair Arthrplasty with r withut Prsthesis Limitatins Clinical privileges are granted nly t the extent privileges are available at each facility. Darkly shaded areas represent privileges nt available t any practitiner due t the privilege nt being ffered by the facility. * Pdiatry Cre II, III and Special Privileges are excluded at Methdist University Hspital and Le Bnheur Children s Hspital. 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 4/16/14, 7/19/17 8