Cardiology Clinical Privileges
Name: ______
Effective from ______/______/______to ______/______/______
❏Initial privileges (initial appointment)❏Renewal of privileges (reappointment)
All new applicants must meet the following requirements as approved by the governing body, effective: ____/____/____. (Date accepted by PQASC)
Applicant: Check the “Requested” box for each privilege requested. Applicants are responsible for producing required documentation for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Please provide this supporting information separately.
[Department/Program Head or Leaders/ Chief]: Check the appropriate box for recommendation on the last page of this form and include your recommendation for any required evaluation.If recommended with conditions or not recommended, provide the condition or explanation on the last page of this form.
With respect to the "standards for currency", the currency for exams or procedures suggested as a threshold are developed by practitioners in the field and are believed to be fair and reasonable and are not intended as a barrier to practice or service delivery. The focus of the standard is on those who are close to or below the threshold, so the situation can be discussed with the department head, and is not on the precise number for those who are well above the threshold. Regardless of the currency number, acceptable results must be demonstrated, especially for procedures with significant risk. Please review the four principles document for more information.
Other requirements
•Note that privileges granted may only be exercised at the site(s) and/or setting(s) that have sufficient space, equipment, staffing, and other resources required to support the privilege.
•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.
Note: The dictionary will be reviewed over time to ensure it is reflective of current practices, procedures and technologies.
Grandparenting: Physicians holding privileges prior to implementation of the dictionary will continue to hold those privileges as long as they meet currency and quality requirements.
Definition[EB1]
Cardiology is the medical subspecialty concerned with the prevention, diagnosis, management, and rehabilitation of patients with diseases of the cardiovascular system.
Qualifications for cardiology
Initial privileges: To be eligible to apply for privileges in cardiology, the applicant must meet the following criteria:
Certification as a Cardiologist by the Royal College of Physicians and Surgeons of Canada (RCPSC)
AND/OR
Recognition as a Cardiologist by the College of Physicians and Surgeons of British Columbia by virtue of credentials earned in another jurisdiction that are acceptable to both the College and the governing body of (organization name).
Required current experience[EB2]:
Renewal of privileges[EB3]:
Return to currency:[EB4]
Core privileges: Cardiology
❑ Requested Admit, evaluate, diagnose, treat, and provide consultation to youth, primarily aged 18 or older, and adult patients, presenting with diseases of the heart and blood vessels and management of complex cardiac conditions. May provide care to patients in an intensive care setting in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.
Core procedures list
This is not intended to be an all-encompassing procedures list. It defines the types of activities/procedures/privileges that the majority of practitioners in this specialty perform at this organization and inherent activities/procedures/privileges requiring similar skill sets and techniques.
To the applicant: If you wish to exclude any procedures, please strike through the procedures that you do not wish to request, and then initial and date.
Cardiology
- Performance of history and physical exam
- ECG interpretation
- Basic ultrasound cardiovascular imaging
- Exercise and pharmacological stress testing
- Holter monitor testing
- 24hr Blood pressure monitoring
- Tilt table testing
- Temporary transvenous and transcutaneous pacing
- Cardioversion and defibrillation
- Infusion and management of: thrombolytic, antithrombolytic, inotropic and vasoactive agents
- Insertion and management of central venous catheters, pulmonary artery catheters, and arterial lines
- Pericardiocentesis
Qualifications for invasive cardiology[EB5]
Initial privileges: To be eligible to apply for privileges in invasive cardiology, the applicant must be granted core privileges in cardiovascular medicine and meet the following criteria:
Required current experience:
Renewal of privileges:
Return to currency:
Core privileges: Invasive cardiology
❑ Requested Admit, evaluate, diagnose, treat, and provide consultation to adolescent and adult patients 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 in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.
Invasive cardiology
• Central-line placement and venous angiography
• Coronary arteriography
• Diagnostic right- and left-heart cardiac catheterization
• Hemodynamic monitoring with balloon flotation devices
• Insertion of intraortic balloon counter pulsation devices
• Placement of temporary transvenous pacemakers
Qualifications for interventional cardiology
Initial privileges: To be eligible to apply for privileges in interventional cardiology, the applicant must be granted core privileges in cardiovascular medicine and meet the following criteria:
Required current experience:
Renewal of privileges:
Return to currency:
Core privileges: Interventional cardiology
❑ Requested Admit, evaluate, treat, and provide consultation to adolescent and adult patients by use of specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart, as well as technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. May provide care to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.
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 of coronaries
• Management of mechanical complications of percutaneous intervention
• Performance of balloon angioplasty, stents, and other commonly used interventional devices
• Percutaneous transluminal septal myocardial ablation
• Use of intracoronary Doppler and flow wire
• Use of vasoactive agents for epicardial and microvascular spasm
Qualifications for clinical cardiac electrophysiology (CCEP)
Initial privileges: To be eligible to apply for privileges in CCEP, the applicant must qualify for and be granted core privileges in cardiovascular medicine and meet the following criteria:
Required current experience:
Renewal of privileges:
Return to currency:
Core privileges: Clinical cardiac electrophysiology
❑ Requested Admit, evaluate, treat, and provide consultation to acute and chronically ill adolescent and adult patients with heart rhythmdisorders, including the performance of invasive diagnostic and therapeutic cardiac electrophysiology procedures. May providecare to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine thedisposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultativecall services. The core privileges in this specialty include the procedures on the attached procedures list and such other proceduresthat are extensions of the same techniques and skills.
Clinical cardiac electrophysiology
• Insertion and management of CIEDs, including ICDs, pacemakers (including single/dual chamber and biventricular, CRTs, implantable loop recorders, and implantable cardiovascular monitors
• Interpretation of activation sequence mapping recordings and 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
• Performance of therapeutic catheter ablation procedures
• Transvenous lead extraction
Non-core Privileges (See Specific Criteria)
Non-core privileges are permits for activities that require further training, experience and demonstrated competence.
Non-core privileges are requested individually in addition to requesting the core.
Each individual requesting non-core privileges should meet the specific threshold criteria as outlined.
Non-core privileges: Nuclear Cardiology
❑ Requested
Non-core privileges: Echocardiography I (Canadian Society of Echocardiography (CSE) Level I)
❑ Requested
Non-core privileges: Echocardiography II (CSE Level II), may include transesophageal, stress, and contrast echocardiography
❑ Requested
Non-core privileges: Echocardiography III (CSE Level III), may include 3-D and intraoperative echocardiography
❑ Requested
Non-core privileges: Electrophysiology – including invasive diagnostic and therapeutic electrophysiology procedures
❑ Requested
Non-core privileges: Implantable Cardiac Defibrillator (ICD) Implantation
❑ Requested
Non-core privileges: Cardiac Resynchronization Therapy (CRT)
❑ Requested
Non-core privileges: Laser Lead Extraction
❑ Requested
Non-core privileges: Interventional Cardiology—including diagnostic procedures (cardiac catheterization, aortography, selective arteriography, and coronary angiography, with femoral, radial, and other artery puncture), standard percutaneous coronary interventions (intracoronary angioplasty, catheter aspiration thrombectomy, and stent insertion), and IABP
❑ Requested
Non-core privileges: Pacemaker Implantation, including implantable loop recorders
❑ Requested
Non-core privileges: Special Intracoronary Diagnostic Imaging (FFR, OCT, IVUS)
❑ Requested
Non-core privileges: Special Intracoronary Therapies—including rotablator and excimer laser angioplasty
❑ Requested
Non-core privileges: Balloon Valvuloplasty
❑ Requested
Non-core privileges: Transcatheter Heart Valve (THV) Implantation
❑ Requested
Non-core privileges: Mechanical Circulatory Support (Impella)
❑ Requested
Context Specific Privileges
Context refers to the capacity of a facility to support an activity.
Context specific privileges: Administration of procedural sedation
❑Requested
See “Hospital Policy for Sedation and Analgesia by Non-anesthesiologists.”
Acknowledgment of Practitioner
I have requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and for which I wish to exercise at [facility name], and I understand that:
- In exercising any clinical privileges granted, I am constrained by hospital and medical staff policies and rules applicable generally and any applicable to the particular situation.
- Any restriction on the clinical privileges granted to me is waived in an emergency situation, and in such situation my actions are governed by the applicable section of the medical staff bylaws or related documents.
Signed: ______Date: ______
[Department/Program Head or Leaders/Chief]’s Recommendation
I have reviewed the requested clinical privileges and supporting documentation for the above-named applicant and:
❑Recommend all requested privileges
❑Recommend privileges with the following conditions/modifications:
❑Do not recommend the following requested privileges:
Privilege Condition/modification/explanation
Notes: ______
______
______
______
[Department/Program Head or Leaders/ Chief ] Signature: ______
Date:______
FOR MEDICAL AFFAIRS USE ONLY (Tailor to Health Authority Process)
Credentials committee action Date:______
Medical executive committee action Date: ______
Board action Date:______
1
Cardiology
Version: Working Copy 5-June-2014
[EB1]From Royal College Objectives of Training
[EB2]Meeting Three
[EB3]Meeting Three
[EB4]Meeting Three
[EB5]Please remind me were we deleting the sections which I have put in grey font?