Pulmonary Medicine Clinical Privileges

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Pulmonary Medicine Clinical Privileges

  1. 1. Pulmonary and Critical Care Medicine Clinical Privileges Name:______________________________________________________________________________ (Please Print) To be eligible to apply for core privileges in pulmonary medicine, the applicant must meet the following qualifications: • Current certification or active participation in the examination process leading to certification in pulmonary medicine by the American Board of Internal Medicine or the American Osteopathic Board of Internal Medicine with Special Qualifications in pulmonary diseases. Or • Successful completion of an ACGME- or AOA-accredited post-graduate training program in internal medicine followed by post-graduate training in pulmonary disease. And • Documentation of the provision of inpatient or consultative services for at least 50 patients during the past 12 months or demonstrate successful participation in a hospital-affiliated formalized residency or special clinical fellowship. And • Applicants have the burden of producing information deemed adequate by the hospital for a proper evaluation of current competence, and other qualifications and for resolving any doubts. Pulmonary Medicine Core Privileges  RequestedAdmit, evaluate, diagnose, treat and provide consultation to patients of all ages, except as specifically excluded from practice, presenting with conditions, disorders, and diseases of the organs of the thorax or chest; the lungs and airways, cardiovascular and tracheobronchial systems, esophagus and other mediastinal contents, diaphragm, circulatory system. Privileges include but are not limited to interpretation of pulmonary functions testing, bronchoscopy, thoracoscopy, and management of mechanical ventilation. Special procedures/techniques (see Qualifications and/or specific criteria*) To be eligible to apply for a special procedure listed below, the applicant must demonstrate successful completion of an approved, recognized course when such exists, or acceptable supervised training in residency, fellowship or other acceptable experience, and provide documentation of competence in
  2. 2. Pulmonary and Critical Care Medicine Clinical Privileges Name:______________________________________________________________________________ (Please Print) performing that procedure consistent with the criteria set forth in medical staff policies governing the exercise of specific privileges. Pleural biopsy  Requested Insertion and management of central venous catheters  Requested Polysomnography (sleep disorders)  Requested[Requires: successful completion of a one year training program in sleep medicine, under the supervision of a diplomates of the American Board of Sleep Medicine or successful completion of a fellowship by the American Sleep Disorders Association; and demonstrated competence in all aspects of polysomnographics, including administering, scoring, and interpreting polysomnograms.] Practice Pathway [For the first five years, 2007 through 2011, ABIM diplomats who have not completed 12 months of formal training in sleep medicine following training in internal medicine or a subspecialty will be eligible to apply for the sleep medicine examination if they can provide the following: Attestation of the equivalent of 12 months of full-time post-training experience providing clinical care of patients with sleep disorders, accumulated over a maximum of five years prior to application for examination and involving minimum experience of evaluating 400 patients, as well as interpreting and reviewing raw data of 200 polysomnograms and 25 multiple sleep latency tests. The Board reserves the right to audit this information. (Partial training in sleep medicine – that is – less than 12 months – will be counted on a month by month basis as practice experience, provide that it has not been credited toward requirements for admission to another ABIM examination]. To be eligible to apply for core privileges in critical care medicine, the applicant must meet the following qualifications: • Practitioners having critical care privileges at NBIMC will be grandfathered as of 9/22/2009. Or • New applicants after 9/22/2009 must demonstrate current certification or active participation in the examination process leading to certification by the American Board of Medical Specialties, or the American Osteopathic Boards in Critical Care Medicine. 2
  3. 3. Pulmonary and Critical Care Medicine Clinical Privileges Name:______________________________________________________________________________ (Please Print) Applicants who have successfully trained in Critical Care Medicine and present evidence of such training will have three years from the time of application to acquire board certification. Certification in Critical Care Medicine must be continually maintained in order to admit and manage patients in the ICU. And • All applicants will be required to provide evidence of active critical care practice through documentation of 60 critical care patients within the prior two year period, 30 of which must be within the immediate one year period. And • All applicants will maintain current ACLS Certification (effective January 31, 2010). And • Applicants have the burden of producing information deemed adequate by the hospital for a proper evaluation of current competence, and other qualifications and for resolving any doubts. Critical care core privileges RequestedAdmit, evaluate, diagnose and provide treatment or consultative services to patients of all ages except where specifically excluded from practice, with multiple organ dysfunction and in need of critical care for life threatening disorders. The attached procedure list reflects the scope of practice included in this core. The core privileges in this specialty include the procedures on the attached list and such other procedures that are extensions of the same techniques and skills. Special procedures/techniques (see Qualifications and/or specific criteria*) To be eligible to apply for a special procedure listed below, the applicant must demonstrate successful completion of an approved, recognized course when such exists, or acceptable supervised training in residency, fellowship or other acceptable experience, and provide documentation of competence in performing that procedure consistent with the criteria set forth in medical staff policies governing the exercise of specific privileges. Tube thoracostomy Requested Gastroesophageal balloon tamponade Requested 3
  4. 4. Pulmonary and Critical Care Medicine Clinical Privileges Name:______________________________________________________________________________ (Please Print) Pericardiocentesis Requested Diagnostic peritoneal lavage Requested Continuous arteriovenous hemofiltration and dialysis Requested Critical Care Medicine Procedures Please delete and initial any procedure that you are not requesting included in the core. ● Management of life-threatening disorders in intensive care units, including but not limited to shock, coma, heart failure, trauma, respiratory arrest, drug overdose, massive bleeding, diabetic acidosis, and kidney failure ● Airway maintenance intubation, including fiberoptic bronchoscopy ● Arterial puncture ● Basic and advanced cardiopulmonary resuscitation ● Bladder catherization ● Bronchoscopy ● Calculation of oxygen content, intrapulmonary shunt, and alveolar arterial gradients ● Calibration and operation of hemodynamic recording systems ● Cardiac output determinations by thermodilution and other techniques ● Cardioversion ● Cardiac pacemaker insertion and application ● Echocardiography and electrocardiography interpretation ● Extracorporeal membrane oxygenation ● Establishment and maintenance of open airway in nonintubated, unconscious, and paralyzed patients ● Evaluation of ogliguria ● Insertion and management of chest tubes ● Insertion of central venous, arterial, and pulmonary artery balloon flotation catheters ● Insertion of hemodialysis and peritoneal dialysis catheters ● Interpretation of electrocardiogram ● Intracranial pressure monitoring ● Lumbar puncture ● Laryngoscopy ● Maintenance of circulation with arterial puncture and blood sampling ● Management of anaphylaxis and acute allergic reactions ● Management of massive transfusions ● Management of pneumothorax (needle insertion and drainage systems) ● Management of the immunosuppressed patient ● Monitoring and assessment metabolism and nutrition 4
  5. 5. Pulmonary and Critical Care Medicine Clinical Privileges Name:______________________________________________________________________________ (Please Print) ● Needle and tube thoracostomy ● Paracentesis ● Percutaneous needle aspiration ● Percutaneous tracheostomy/cricothyrotomy tube placement (Seldinger technique) ● Pericardiocentesis/transvenous pacemaker insertion ● Pressure-cycled, volume-cycled, time-cycled, and flow-cycled invasive and non-invasive mechanical ventilation ● Thoracentesis ● Thoracoscopy ● Transtracheal catherization ● Tracheostomy ● Use of reservoir masks and continuous positive airway pressure masks for delivery of supplemental oxygen, humidifiers, nebulizers, and incentive spirometry ● Ventilator management, including experience with various modes 5
  6. 6. Pulmonary and Critical Care Medicine Clinical Privileges Name:______________________________________________________________________________ (Please Print) Acknowledgement 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 Newark Beth Israel Medical Center, 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 __________________________________ _______________ Applicant’s Signature Date Department Chair’s Recommendation I have reviewed the requested clinical privileges and supporting documentation for the above-named applicant and make the following recommendation(s): Recommend all requested privileges Recommend all requested privileges with the following conditions/modifications:  Do not recommend the following requested privileges: Privilege Condition/Modification/Explanation 1. 2. 3. 4. Notes: _________________________________ _________________________ Signature Division Director Date _________________________________ _________________________ Signature Department Chair Date 6/09 6

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