Thoracic Surgery 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 Health Authority or Hospital, 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
Thoracic Surgery is that branch of surgery concerned with congenital and acquired diseases of the chest wall, mediastinum, lungs, trachea, pleura, esophagus, stomach and diaphragm.
Qualifications for Thoracic Surgery
Initial privileges: To be eligible to apply for privileges in thoracic surgery, the applicant must meet the following criteria:
Be certified as a Thoracic Surgeon by the Royal College of Physicians and Surgeons of Canada (RCPSC)
AND
Be recognized as a Thoracic Surgeon by the College of Physicians and Surgeons of British Columbia (CPSBC)
AND
Required current experience: Thoracic surgical practice (including procedures), reflective of the scope of privileges requested, in the past 12 months and practicing as a .5 FTE, by BC standards.
Renewal of privileges: To be eligible to renew privileges in thoracic surgery, the applicant must meet the following criteria:
Current demonstrated competence (metrics not defined or measured at this time) and an adequate volume of experience (minimum .5 FTE as defined by MOH[1]), reflective of the scope of privileges requested, for the past 12 months based on results of ongoing professional practice evaluation and outcomes (no current tool).
Core privileges: Thoracic surgery
❑ Requested Admit, evaluate, diagnose, and provide operative, perioperative, and critical care to patients of all ages with pathological conditions within the chest. Includes; cancers of the lung, esophagus, and chest wall; abnormalities of the trachea; congenital anomalies of the chest, tumors of the mediastinum; and diseases of the diaphragm. 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 procedure 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.
Thoracic surgery
• Performance of history and physical exam
• Cervical, thoracic, or dorsal sympathectomy
• Correction of diaphragmatic hernias, both congenital or acquired, and antireflux procedures
• Decortication or pleurectomy procedures
• Diagnostic procedures, including cervical and mediastinal exploration, parasternal exploration, and mediastinoscopy
• Endoscopic procedures, including bronchoscopy, esophagoscopy, and mediastinoscopy
• Implantation of cardioverter defibrillator
• Lymph node and superficial biopsy procedures
• Management of chest and neck trauma
• Operations for achalasia and for promotion of esophageal drainage
• Pericardiocentesis, pericardial drainage procedures, and pericardiectomy
• Procedures upon the chest wall, pleura, and lungs, including wedge resections, segmentectomy, lobectomy, and pneumonectomy
• Resection, reconstruction, or repair of the trachea and bronchi
• Resection, reconstruction, repair, or biopsy of the lung and its parts
• Surgery on the esophagus, mediastinum, and diaphragm, including surgery for diverticulum, as well as perforation, resections, transhiatal esophagectomy, surgery for benign esophageal disease, and surgery on mediastinum for removal of benign or malignant tumors
• Thoracentesis
• Thoracoscopy
• Thoracotomy for trauma, hemorrhage, rib biopsy, drainage of empyema, or removal of foreign body
• Tracheostomy
• Tube thoracostomy
• Video-assisted thoracoscopic surgery
Non-core Privileges (See Specific Criteria)
Non-core privileges may be requested for by individuals who have 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: Use of laser
❑ Requested
Initial privileges: Successful completion of an approved residency in a specialty or subspecialty that included training in laser principles or completion of an approved 8- to 10-hour minimum continuing medical education course that included training in laser principles. In addition, an applicant for privileges should spend time after the basic training course in a clinical setting with an experienced operator who has been granted laser privileges acting as a preceptor. Practitioner agrees to limit practice to only the specific laser types for which he or she has provided documentation of training and experience. The applicant must supply a certificate documenting that he or she attended a wavelength and specialty-specific laser course and also present documentation as to the content of that course.
AND
Required current experience: Demonstrated current competence and evidence of the performance of at least [n] procedures 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 at least [n] procedures in the past 24 months based on results of ongoing professional practice evaluation and outcomes.
Source: American Society for Laser Medicine and Surgery, April 2008.
Non-core privileges: Use of robotic-assisted system
❑ Requested Oncologic procedures (esophageal tumors, solid thoracic tumors, and thymoma and retromediastinal tumors)
❑ Requested Cardiothoracic procedures (sternotomy and thoracotomy, coronary bypass, mitral valve repair, atrial septal defect repair, pericardiectomy, lobectomies and tumor enucleations, and single-lung, double-lung, and heart/lung transplantations (excluding that for infants and young children)
Initial privileges: Successful completion of an ACGME or AOA postgraduate training program that included training in minimal access procedures and therapeutic robotic devices and their use or completion of an approved structured training program that included didactic education on the specific technology and an educational program for the specialty-specific approach to the organ systems. Training should include observation of live cases. Physician must have privileges to perform the procedures being requested for use with the robotic system, hold privileges in or demonstrate training and experience in minimal access procedures. Practitioner agrees to limit practice to only the specific robotic system for which they have provided documentation of training and experience.
AND
Required current experience: Demonstrated current competence and evidence of at least [n] robotic-assisted procedures in the past 12 months, successful completion of training in the past 12 months, or the applicant’s initial [n] cases will be proctored by a physician holding robotic privileges.
Renewal of privilege: Demonstrated current competence and evidence of at least [n] robotic-assisted procedures in the past 24 months based on results of ongoing professional practice evaluation and outcomes.
Source: Society of American Gastrointestinal and Endoscopic Surgeons and the Minimally Invasive Robotic Association, 2006.
Non-core privileges: Single-lung, double-lung, and heart transplantations (excluding that for infants and young children)
❑ Requested
Initial privileges: Successful completion of an American Society of Transplant Surgeons (ASTS)–approved transplant fellowship training program or completion of a two-year formal transplant fellowship at a transplant program meeting United Network for Organ Sharing (UNOS) membership criteria in lung transplantation. In lieu of one year of formal transplant fellowship training and one year of experience or a two-year formal transplant fellowship, three years of experience with a transplant program meeting the criteria for acceptance into UNOS will suffice. Current certification by the American Board of Thoracic Surgery or its equivalent is required. If board certification in thoracic surgery is pending (as is the case if one just finished residency), conditional approval may be granted for a 24-month period, with the possibility of it being renewed for an additional 24-month period to allow time for the completion of certification.
AND
Required current experience: Documentation of the performance of 15 or more lung and/or heart transplants, of which at least half must be single- or double-lung procedures, during residency as the primary surgeon or first assistant or documentation of the performance of 10 or more lung procurement procedures as the primary surgeon or first assistant under the supervision of a qualified lung transplant surgeon. The above training must have been at a medical center with a cardiothoracic training program approved by the American Board of Thoracic Surgery and/or UNOS.
Renewal of privileges: Demonstrated current competence and evidence of the performance of at least [n] single- or double- lung procedures in the past 24 months based on results of ongoing professional practice evaluation and outcomes.
Source: United Network for Organ Sharing.
Context Specific PrivilegesContext refers to the capacity of a facility to support an activity
Administration of sedation and analgesia
❑ Requested
See “Hospital Policy for Sedation and Analgesia by Nonanesthesiologists.”
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:
a. 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.
b. 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: ______
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[1] A British Columbia Clinical Thoracic Surgery FTE is defined by the Ministry of Health and is accepted by all the Health Authorities