Pathology Clinical Privileges

Pathology 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: ____/____/____.

If any privileges are covered by an exclusive contract or an employment contract, practitioners who are not a party to the contract are not eligible to request the privilege(s), regardless of education, training, and experience. Exclusive or employment contracts are indicated by [EC].

Applicant: Check the “Requested” 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.

[Department chair/chief]: Check the appropriate box for recommendation on the last page of this form and include your recommendation for focused professional practice evaluation.[1]If recommended with conditions or not recommended, provide the condition or explanation on the last page of this form.

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.

Qualifications for General Pathology

Description: A General Pathologist is a specialist who is trained in diagnosis and in laboratory management, incorporating and integrating all aspects of laboratory methodology, playing a key role in quality assurance and the introduction of emerging technologies. This includes providing consultation to medical colleagues using morphologic techniques such ashistopathology, cytology, autopsy, forensics and clinical laboratory methods, namely biochemistry, laboratory hematology, blood transfusion and microbiology. General Pathology is distinct because the training is divided between Anatomical Pathology and clinical laboratory medicine. General Pathologists are trained to practice in a variety of settings including large metropolitan, regional, and community hospitals, and may play a role in teaching or research. General Pathology can also be a route for sub-specialty or diploma training.

Initial privileges: To be eligible to apply for privileges in pathology (anatomic, clinical), the applicant must meet the following criteria:

Certification in General Pathology by the Royal College of Physicians and Surgeons of Canada or be recognized as a general pathologist 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 organization.

AND

Required current experience: Full- or part-time pathology services, reflective of the scope of privileges requested, forthe past 12 months or successful completion of an ACGME- or AOA-accredited residency or clinical fellowship within thepast 12 months.

Renewal of privileges: To be eligible to renew privileges in pathology, the applicant must meet the following criteria:

Current demonstrated competence and an adequate volume of experience [full or part time] with acceptable results, reflective of the scope of privileges requested, for the past 24 months based on results of ongoing professional practice evaluationand outcomes. Evidence of current physical and mental ability to perform privileges requested is required of all applicants forrenewal of privileges.

Core privileges: General pathology - anatomic

❑ Requested Patient diagnosis, ordering, consultation, and laboratory medical direction in the following disciplines:surgical pathology (including intraoperative consultations), cytopathology, autopsy pathology, immunohistochemistry, and associatedancillary studies. Adherence to medical staff policy regarding emergency and consultative call services. The coreprivileges include the procedures listed on the attached privileges list and such other procedures that are extensions ofthe same techniques and skills.

Core privileges: General pathology - clinical

❑ Requested Patient diagnosis, ordering, consultation, and laboratory medical direction in the following clinical pathology disciplines: hematology and coagulation, blood bank and immunohematology, microbiology, serology, molecular pathology, clinical chemistry (including the subdivisions of special chemistry, automated chemistry, endocrinology, radioimmunoassay, toxicology, and electrophoresis), clinical microscopy, and other routine clinical pathology functions. Adherence to medical staff policy regarding emergency and consultative call services. The core privileges include the procedures listed on the attached privileges list and such other procedures that are extensions of the same techniques and skills.

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.

General anatomic pathology

Fine-needle aspiration and biopsy procedures (including ultrasound guided) and reporting of the specimens obtained
Interpretation and reporting of papanicolaou-stained smears
Interpretation and reporting of surgical pathology
Autopsy, including forensic autopsy
Interpretation and reporting of immunohistochemical investigations

General Clinical pathology

Clinical consultation for conditions involving transfusion, coagulation, metabolic and molecular disease
Interpret and report Gram stains
Interpret and report blood and marrow specimens
Interpret and report coagulation studies

Non-core privileges: Bone marrow biopsy

❑ Requested

Initial privileges: Successful completion of Royal College of Physicians and Surgeons of Canada (or equivalent) accredited postgraduate training in anatomic, general or hematological pathology that included training in bone marrow biopsy.

AND

Required current experience: Demonstrated current competence and evidence of the performance of [n] bone marrowbiopsies in the past 12 months or completion of training in the past 12 months.

Renewal of privileges: Demonstrated current competence and evidence of the performance of [n] bone marrow biopsies inthe past 24 months based on results of ongoing professional practice evaluation and outcomes.

Other non-core privileges requiring proctoring and experience approved by department head

General Pathology

Medical microbiology including identification of microorganisms, interpreting and reporting antibiotic susceptibility testing and management of an antibiotic stewardship program ❑ Requested

Qualifications for Anatomic Pathology

Description: Anatomical Pathology is that branch of laboratory medicine concerned with the study of the morphologic aspects of disease. It includes the subdomains of cytopathology, gynecological pathology, dermatopathology, gastrointestinal pathology, cardiovascular pathology, respiratory pathology, musculoskeletal pathology, renal pathology, genito-urinary pathology, endocrine pathology, ophthalmic pathology, head and neck pathology, neuropathology, pediatric pathology, forensic pathology, and certain laboratory methods such as immunohistochemistry, immunofluorescence, in-situ hybridization, flow cytometry, molecular pathology, electron microscopy.

Initial privileges: To be eligible to apply for privileges in cytopathology, the applicant must meet the following criteria:

Certification in Anatomic Pathology by the Royal College of Physicians and Surgeons of Canada or be recognized as a anatomic pathologist 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 organization.

AND

Required current experience: Full- and/or part-time anatomic pathology services, reflective of the scope of privileges requested,for the past 12 months or successful completion of a Royal College of Physicians and Surgeons of Canada residency in anatomic pathology (or equivalent) or clinical fellowship within thepast 12 months.

Renewal of privileges: To be eligible to renew privileges in anatomic pathology, the applicant must meet the following criteria:

Current demonstrated competence and an adequate volume of full- or part-time experience with acceptable results, reflective of the scope of the privileges requested, for the past 24 months based on results of ongoing professional practice evaluationand outcomes. Evidence of current physical and mental ability to perform privileges requested is required of all applicants forrenewal of privileges.

Core privileges: Anatomic pathology

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.

Anatomic pathology

Fine-needle aspiration and biopsy procedures (including ultrasound guided) and reporting of the specimens obtained
Interpretation and reporting of papanicolaou-stained smears
Interpretation and reporting of surgical pathology
Autopsy, including forensic autopsy
Interpretation and reporting of immunohistochemical investigations

Non-core privileges: Bone marrow biopsy

❑ Requested

Initial privileges: Successful completion of an ACGME- or AOA-accredited postgraduate training in anatomic, general or hematological pathology that included training in bone marrow biopsy.

AND

Required current experience: Demonstrated current competence and evidence of the performance of [n] bone marrowbiopsies in the past 12 months or completion of training in the past 12 months.

Renewal of privileges: Demonstrated current competence and evidence of the performance of [n] bone marrow biopsies inthe past 24 months based on results of ongoing professional practice evaluation and outcomes.

Other non-core privileges requiring proctoring and experience approved by department head

Anatomic Pathology

Flow cytometry❑ Requested
Immunofluoresence❑ Requested
Molecular pathology❑ Requested
Electron microscopy❑ Requested
In situ hybridization❑ Requested

Qualifications for Forensic Pathology

Description: Forensic Pathology is a subspecialty of Anatomical Pathology and General Pathology which applies basic pathologic principles and methodologies of these two specialties to support the medicolegal and judicial systems in determining causes and manners of death, supporting the investigation of circumstances surrounding deaths, and assisting in the interpretation of postmortem findings of medical legal significance.

Initial privileges: To be eligible to apply for privileges in cytopathology, the applicant must meet the following criteria:

Certification in General or Anatomic Pathology by the Royal College of Physicians and Surgeons of Canada or be recognized as a general or anatomic pathologist 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 organization.

AND

Certification in Forensic Pathology by the Royal College of Physicians and Surgeons of Canada or be recognized as a forensic pathologist 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 organization.

AND

Required current experience: Full- and/or part-time forensic pathology services, reflective of the scope of privileges requested,for the past 12 months or successful completion of a Royal College of Physicians and Surgeons of Canada residency in forensic pathology (or equivalent) or clinical fellowship within thepast 12 months.

Renewal of privileges: To be eligible to renew privileges in anatomic pathology, the applicant must meet the following criteria:

Core privileges: Forensic pathology

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.

Forensic Patbology

Investigate and report causes and manners of death, supporting the investigation of circumstances surrounding deaths, and assisting in the interpretation of postmortem findings of medical legal significance, including suspicious infant death and the investigation of human skeletal remains.

Other non-core privileges requiring proctoring and experience approved by department head

Qualifications for neuropathology

Description: Neuropathology is the laboratory specialty concerned with the investigation and diagnosis of primary and secondary diseases of the central and peripheral nervous systems and skeletal muscle.

Initial privileges: Certification in Neuropathology by the Royal College of Physicians and Surgeons of Canada or be recognized as a neuropathologist 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 organization.

AND

Required current experience: Full- and/or part-time neuropathology services, reflective of the scope of privileges requested,for the past 12 months or successful completion of a Royal College of Physicians and Surgeons of Canada residency in neuropathology (or equivalent) or clinical fellowship within thepast 12 months.

Renewal of privileges: To be eligible to renew privileges in neuropathology, the applicant must meet the following criteria:

Current demonstrated competence and an adequate volume of full- or part-time experience with acceptable results, reflective of the scope of privileges requested, for the past 24 months based on results of ongoing professional practice evaluationand outcomes. Evidence of current physical and mental ability to perform privileges requested is required of all applicants forrenewal of privileges.

Core privileges: Neuropathology

❑ Requested Diagnose diseases of the nervous system and skeletal muscles,including the infirmities as they affect the nervous and neuromuscular systems, whether degenerative, infectious, metabolic, immunologic, neoplastic, vascular, or physical in nature by use of scientific studies of the tissues, cells, and body fluids. Apply technologies including immunohistochemistry, electron microscopy and immunofluorescence. 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 include the procedures listed on the attached privileges list and such other procedures that are extensions of the same techniques and skills.

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.

Neuropathology

Autopsy examination related to the nervous and musculoskeletal systems
Interpretation and reporting of immunohistochemical investigations
Interpretation and reporting of electron microscopy studies
Interpretation and reporting of investigations employing immunofluorescence
Interpretation and reporting of diagnostic neurocytology cases
Clinical consultation

Other non-core privileges requiring proctoring and experience approved by department head

Neuropathology

Interpretation and reporting of molecular investigations including in-situ hybridization

❑ Requested

Qualifications for Medical Microbiology

Description: Medical Microbiology is a branch of laboratory and clinical medicine concerned primarily with the diagnosis, treatment and prevention of infectious diseases. The specialty of Medical Microbiology consists of four general spheres of activity:

1. Scientific development, and administrative and clinical direction of a microbiology laboratory.

2. Clinical consultations, in both in-patient and out-patient settings, on the investigation, diagnosis, treatment, and prevention of infectious diseases.

3. Infection Prevention and Control, and antibiotic stewardship.

4. The epidemiology of communicable diseases.

Initial privileges: Certification in Medical Microbiology by the Royal College of Physicians and Surgeons of Canada or be recognized as a medical microbiologist 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 organization.

AND

Required current experience: Full- and/or part-time medical microbiology services, reflective of the scope of privileges requested,for the past 12 months or successful completion of a Royal College of Physicians and Surgeons of Canada residency in medical microbiology (or equivalent) or clinical fellowship within thepast 12 months.

Renewal of privileges: To be eligible to renew privileges in medical microbiology, the applicant must meet the following criteria:

Core privileges: Medical Microbiology

❑ Requested Diagnose and monitor diseases caused by microorganisms, for patients of all ages. Assess, stabilize, and determine the disposition of patients with emergent conditionsconsistent with medical staff policy regarding emergency and consultative call services. The core privileges include theprocedures listed on the attached privileges list and such other procedures that are extensions of the same techniquesand skills.

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.

Medical Microbiology

Clinical consultation for diseases caused by microorganisms
Interpretation and reporting of microscopy specimens including Gram stains
Interpretation and reporting of antibiotic susceptibility testing
Interpretation and reporting of microbial identification investigations
Consultation for the following:
Infection prevention and control
Implementation and monitoring of new technologies related to the discipline
Point of care testing devices
Management of an antibiotic stewardship program

Other non-core privileges requiring proctoring and experience approved by department head

Medical Microbiology

Investigation and reporting of virological disease❑ Requested

Qualifications for Medical Biochemistry

Definition: Medical Biochemistry is a branch of medicine concerned with the biochemistry and metabolism in human health and disease. The Medical Biochemist is a specialist in laboratory medicine, is trained in the operation and management of clinical biochemistry laboratories, and acts as a consultant in all aspects of their use. The medical biochemist directs clinical laboratories, consults, diagnoses and treats patients with a variety of metabolic disorders and biochemical abnormalities.