RENOWNSOUTHMEADOWSMEDICALCENTER

DELINEATION of PRIVILEGES

DEPARTMENT OF SURGERY

ORTHOPAEDICS

Basic Education: M.D. or D.O.

Minimal Formal Training: ABMS Board certification or eligibility, or be able to document equivalent training and/or experience which is deemed acceptable on an individual basis by the Renown Regional Medical Center Orthopedic Department (minimum equivalency, successful completion of a five-year post-graduate residency program in orthopedic surgery approved by the ACGME).

BOARD CERTIFICATION:

Those applicants who are not board certified at the time of application but who have completed their residency or fellowship training within the last five years shall be eligible for Medical Staff appointment. However, in order to remain eligible, those applicants must achieve board certification in their primary area of practice within five (5) years from the date of completion of their residency or fellowship training.

Required Previous Experience: For individuals who have just completed an approved residency a letter from their program chairman supporting the granting of the privileges requested is necessary. For all others, the successful applicant must document performance of at least 100 orthopedic surgical procedures during the past 12 months.

Privileges Requested

Orthopaedic Surgery Delineation of Privileges Page 1 of 1

____84.91Amputation

____81.20Arthrodesis

____81.96Arthroplasty

____81.91Drainage - bone

____78.00Graft - bone

____79.70Closed reduction, dislocation

or fracture dislocation

____79.00Closed reduction, fracture

____Repair tendons

____83.64Primary

____83.64SSecondary

____83.13Tenotomy

____86.59Wounds - major

____04.81Peripheral nerve surgery

____86.69Skin Grafting

Orthopaedic Surgery Delineation of Privileges Page 1 of 5

SPECIAL REQUESTS: These procedures require additional documentation.

I.Proper training when used in the listing of each specific privilege would imply that the surgeon has been under the supervision of someone who is skilled in the procedure. In certain instances it may imply a formal surgical residency training program, such as those in the AMA Guide to Approved Residencies or equivalent training. In certain instances it will imply that further training will be necessary if the procedures were not a part of the formal residency program.

II.If the applicant is a recent graduate of a residency training or fellowship program, the applicant may submit a list of cases performed, which is signed by the department chair. If the applicant has been in practice, then copies of the operative reports are required to satisfy RenownRegionalMedicalCenter and RenownSouthMeadowsMedicalCenter rules.
____Laser Privileges (LS.CO, LS.YG)

1.The CO2, laser require specific application by all orthopedic surgeons who request the privilege in arthroscopies. All applications must be accompanied by supporting documentation of the applicant's training and experience, specifically a recent course in laser surgery with hands-on experience.

OR

Formal training in residency training.

2.Proctoring for the first three cases.

____Open reduction, internal fixation of fractures and/or osteotomies, AO/ASIF (OR.IF)

1.Completed an orthopaedic surgery residency subsequent to 1989, submit a letter from residency director documenting competence in AO/ASIF techniques,

OR

Completed a residency prior to 1989, submit

a.Certificate of completion of the AO/ASIF basic course.

b.Document 50 cases of ORIF using AO/ASIF techniques.

2.The assigned mentor, the Department, and the Department Chief all reserve the right to challenge an applicant's competence, including AO/ASIF techniques, by oral examination prior to completion of the probationary period as well as prior to advancement to Active Staff. If in the course of mentoring it becomes apparent that the applicant's skill and judgment do not meet acceptable standards, the Department reserves the right to require the applicant to participate in a AO/ASIF fracture course, either for the first time or as repeated training.

____Arthroscopy (80.20)

1.Proper training.

2.Documentation of 50 arthroscopic cases.

3.Documentation of 5 cases of arthroscoping the specific joint which privileges are requested.

____Implant arthroplasty (81.96)

  1. Proper training.
  2. Documentation of 15 cases of replacement arthroplasty.

3.Documentation of five cases of the specific joint, which is to be replaced, possibly presenting x-rays as needed.

____

____Arthrotomy, ligament repair and/or reconstruction of major joints, (ankle, knee, hip, shoulder, elbow, wrist) (AR.TH)

1.Proper training.

2.Documentation of 20 cases.

______Moderate (Conscious) Sedation Analgesia

This protocol shall assist in determining the competence of non-anesthesiologists (M.D./D.O./D.D.S./D.M.D.) to direct moderate sedation/analgesia for procedures performed at the hospital. This protocol endorses the ASA Guidelines for Sedation and Analgesia by Non-anesthesiologists and ASA Physical Status Classes I-IV in determining appropriate candidates for moderate sedation.

QUALIFICATIONS/CRITERIA

  1. eligibility: An individual must meet one of the following prerequisite criteria:
  2. Have completed an ACGME/AOA residency or oral surgery residency.
  3. Have attained ABMS Board Certification.
  4. Maintain a current ACLS Certificate.
  5. Training/Experience in Sedation/Analgesia. In addition to A.1, one of the following is required.
  6. Formal Training: Specialized training in anesthesiology, if attained in an accredited program, as confirmed by the program director. Eligible Oral Surgeons are deemed to have special training in sedation when a current anesthesiology permit is maintained.
  7. Hospital/Privileges: The physician’s approved privileges from a hospital listing sedation/analgesia privileges, or verification of it from the physician responsible for clinical review (Chairman/Chief/Medical Director).
  • Clinical Proficiency: Review of educational and self-assessment materials documenting ability to supervise sedation/analgesia, to include pharmacology, timely intervention and adverse occurrences.
  1. Self-Assessment Proficiency: The applicant will possess proficiency as follows:
  • Pharmacology: Familiarity with the pharmacology, contraindications, agonists, and antagonists used for sedation/analgesia; familiarity with pharmaceutical contraindications and adverse results of agonists and antagonists (use appendix D of this Policy).
  • Didactic Review: Completion of the following:
  • RRMC Guidelines/Protocol for Moderate Sedation/Analgesia for Procedures.
  • Summary of ASA Guidelines for Sedation and Analgesia by Non-anesthesiologists.
  • Successful completion of moderate sedation post test, which evaluates knowledge of pharmacology and didactic review.

elevation to active staff

  • Must be mentored by an Active Staff Orthopaedic Department member who is not affiliated with the Associate Staff member.
  • May be assigned to ER call while being mentored but cannot transfer call other than to another Active Staff Orthopaedic Department member.

Can provide alternate coverage only by an Active Staff Orthopaedic Department member.

Reappointment/Current Clinical Competence:

All members of the Department are reappointed every two years in accordance with the Bylaws and Credentialing Policies of the Medical Staff. Since reappointment is an affirmation of good clinical practice, each applicant will provide evidence of activity sufficient to demonstrate current clinical competence for the privileges requested. All members should have a minimum of 50 cases during the last reappointment period.

______

ApplicantDate

______

Chief, Section of OrthopaedicsDate

Date of Recommendation by the Executive Committee:______

Date of Approval by the Board of Governors: ______

RenownSouthMeadowsMedicalCenter

Orthopaedic Surgery Delineation of Privileges

Approved 10-04, 7-08Page 1 of 4