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Approval of Privilege Forms July 28, 2021 TO: Quality Professional Services Committee FROM: Brandon Boesch, D.O., Alameda Health System Chief of Staff Catherine Pyun, D.O., Alameda Hospital Chief of Staff SUBJECT: Agenda Item: B4 Meeting Date: July 28, 2021 Item Description: Medical Staff Specialty Privilege Forms COMMITTEE ACTION: Approval of revised Medical Staff Privilege Form Background: The specialty privilege form(s) listed in the analysis section are either new privilege forms or revised privileges forms, both designed to offer a systematic approach for care across our facilities (AHS, SLH, AH) as applicable. Analysis: Whether new or revised, the Medical Staff privilege forms are updated through a succinct process using best practice and clinical evidence. Prior Board Action: n/a Board Action Requested: Approval of revised privilege form that offer a system-wide approach for privileges that support patient care at AHS. Revised Privilege Form(s) for AHS and AH: • Emergency Medicine Multifacility • Neurology Multifacility • Teleneurology Multifacility Revised Privilege Form(s) for AHS: • Alameda Hospital Medical Privileges Fiscal Impact: n/a Budgeted/Authorized: n/a Estimated Cost Savings: n/a Strategic Plan Pillar: Access, Quality, Experience AHS Emergency Medicine Multifacility Privileges Delineation of Privileges Applicant's Name: 1. 2. 3. 4. Required Qualifications Membership Meet all requirements for medical staff membership Education/Training For initial applicants, effective January 1, 2020, completion of an ACGME or AOA accredited residency training program in Emergency Medicine. OR Current certification in Emergency Medicine by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine. Continuing Education Applicant must have 25 CME credits per year (waived for applicants who have completed residency training during the previous 24 months) OR Applicant must be active in MOC (maintenance of certification) program in emergency medicine Certification For all new applicants who will be appointed on/after January 1, 2017, current certification or board eligibility in Emergency Medicine by the American Board of Emergency Medicine or in Emergency Medicine by the American Osteopathic Board of Emergency Medicine. Clinical Experience (Initial) Applicant must demonstrate active practice as an Emergency Physician (minimum of 500 cases worked in the prior two year period). Waived for applicants who completed training during the previous year. Clinical Experience Applicant must demonstrate active practice as an Emergency Physician (minimum of 300 cases) (Reappointment) representative of the scope and complexity of privileges requested during the previous 24 months. Published: 7/6/2021 1:12:56 PM AHS Emergency Medicine Multifacility Privileges Page 1 of 6 Primary Privileges in AHS Emergency Medicine Multifacility Privileges Description: Immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of patients in response to acute illness and injury. Focus on the immediate decision making and action necessary to prevent death or any further disability. Request Request all privileges listed below. AHS Core AH - Currently granted privileges Perform history and physical examination Attend, evaluate, diagnose and initially treat patients who present to the emergency department with any symptom, illness, injury or condition, and provide services necessary to ameliorate minor illnesses or injuries; stabilize patients with major illnesses or injuries and assess all patients to determine if additional care is necessary. Inpatient admission Admit and attend adolescents (14-21) years of age Procedures Diagnostic procedures including arthrocentesis; lumbar puncture; slit lamp examination; tonometry; pulse oximetry; arterial blood gas sampling and analysis; EKG; preliminary X-ray interpretation; and occult blood testing. Techniques utilized to stabilize the airway including use of airway adjuncts, rapid sequence intubation with paralytic agent, image-guided and video assisted laryngoscopy Cricothyrotomy Mechanical ventilation - all modes Skeletal procedures including stabilization of fractures and dislocations; immobilization techniques; reduction techniques; backboard and cervical immobilization techniques. Excision of thrombosed hemorrhoids Foreign body removal Gastric lavage Jejunostomy and gastrostomy tube replacement Wound management and closure including management of burns, nail removal, I&D abscess and evacuation of hematoma Laryngoscopy, control of epistaxis, posterior packing and chemical cautery Emergent delivery of newborns; Doppler fetal heart tones; pelvic exam; perimortem C-Section; and removal of IUD Thoracentesis Thoracostomy Pericardiocentesis Emergent thoracotomy Paracentesis and lavage Suprapubic tap and catheterization Urethral dilation Lateral canthotomy Vascular access including arterial catheter insertion; central venous access; venous cutdown Published: 7/6/2021 1:12:56 PM AHS Emergency Medicine Multifacility Privileges Page 2 of 6 Intraosseous infusion Thrombolytic administration Insertion of temporary pacemaker or use of external pacemaker and elective cardioversion FPPE Requirements AHS Core AH Ten (10) retrospective case reviews that are representative the scope and complexity of privileges requested. Special Privilege Cluster: Emergency Focused Ultrasound Description: Investigational ultrasound for trauma or other indication. Qualifications Education/Training Documentation of training and experience during residency OR Emergency medicine physicians who did not receive training during residency should demonstrate at a minimum 25 proctored ultrasounds per primary indication or a minimum of 150 ultrasounds for general emergency ultrasound privileges OR Physicians who completed training greater than 5 years ago must provide evidence of ongoing clinical practice. OR Letter from Emergency Department Ultrasound Director certifying training and experience. Clinical Experience (Initial) Applicant must provide documentation of provision of clinical services representative of the scope and complexity of the privileges requested during the previous year (waived for applicants who completed training during the previous year). Clinical Experience Applicant must provide evidence of ongoing clinical practice representative of the scope of (Reappointment) privileges requested during the past 24 months. Request Request all privileges listed below. AHS Core AH - Currently granted privileges Perform and interpret emergent, focused or investigational ultrasound Published: 7/6/2021 1:12:56 PM AHS Emergency Medicine Multifacility Privileges Page 3 of 6 FPPE Requirements AHS Core AH Five (5) retrospective case reviews Privilege Cluster: Stroke Care Qualifications Education/Training For recent graduates of Emergency Medicine Residency program, physician must have completed at least a 1-month Neurology rotation during Emergency Medicine residency or must attest to supervised management of acute stroke patients (10 cases) during residency. Certification NIH Stroke Scale Certification at initial appointment Clinical Experience (Initial) Applicant must attest to providing (5 cases) representative of the scope and complexity of the privileges requested during the previous year (waived for applicants who completed training during the previous year). Clinical Experience Applicant must have provided clinical services (5 cases) representative of the scope and (Reappointment) complexity of privileges requested during the past 24 months Request Request all privileges listed below. AHS Core AH - Currently granted privileges Stroke care Thrombolytic Therapy - Standard Protocol FPPE Requirements AHS Core AH Ten (10) retrospective case reviews that are representative of the scope and complexity of the privileges requested. Transesophageal Echocardiography (TEE) Description: Directly visualized, focused TEE in cardiac arrest patients with tracheal intubation. Published: 7/6/2021 1:12:56 PM AHS Emergency Medicine Multifacility Privileges Page 4 of 6 Qualifications Education/Training Providers seeking credentialing in transesophageal echocardiography of cardiac arrest applications should have completed training and met competency standards in transthoracic echocardiography and: Completed a minimum of 2-4 hours of TEE-specific CME or didactics; AND Performed a minimum of 10 cardiologist proctored TEE examinations (including probe insertion) on live patients and simulation models; AND Completed a standardized assessment by a credentialed TEE provider Clinical Experience (Initial) 10 procedures performed during previous 12 months (waived for applicants who completed training within the previous year) Clinical Experience 10 procedures performed per year (average over 2 years) (Reappointment) Request Request all privileges listed below. AHS Core AH - Currently granted privileges Focused Transesophageal Echocardiography (TEE) including probe placement, image acquisition and interpretation. FPPE Requirements AHS Core AH Retrospective review of 3 cases Acknowledgment of Applicant I have requested only those privileges for which by education, training, current experience, and demonstrated competency I believe that I am competent to perform and that I wish to exercise at Alameda Health System hospital(s) and I understand that: A. In exercising any clinical privileges granted,
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