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Ask the expert: What are the shortcomings of laundry list privileging?

Credentialing Resource Center Connection, August 19, 2011

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The Joint Commission has indicated that the delineation of clinical privileges need not be so exhaustive, but laundry lists remain a common approach for delineating privileges in hospitals. Despite their popularity, laundry lists have numerous shortcomings:

• No predefined criteria
• Focused on procedures
• Not inclusive
• Complex legal issues
• Tedious administrative time required

Laundry lists are usually not associated with predefined criteria. When practitioners apply for privileges, they simply check off the procedures they would like to perform or the conditions they would like to treat. Typically, the hospital and its medical staff have not defined the criteria that must be met for each requested privilege (there may be criteria for some but not all privileges), even though both The Joint Commission and the Centers for Medicare & Medicaid Services require criteria-based privileging.
When using laundry lists, applicants are not routinely required to provide specific documentation of training and experience to show that they are qualified for all requested privileges. Practitioners have been known to apply for “all privileges listed” because they do not want to take the time to request each procedure or condition. In addition, this approach requires highly trained practitioners to place check marks next to the most mundane clinical conditions or procedures for which they already have been thoroughly trained and for which their qualifications are unquestioned.

Laundry lists are most often procedurally focused. A laundry list commonly includes the procedures that a practitioner might want to perform, but the cognitive areas of practice are often not addressed. Laundry lists are often not inclusive. Because of this drawback, many organizations are tempted to write “other” at the bottom of the request form, which enables practitioners to request to perform  procedures or treat conditions for which the hospital has no predefined privileging criteria or that are outside the scope of services of the hospital.

The legal issues associated with laundry lists are complex. Can an organization demonstrate that it critically reviewed a practitioner’s request when the request was one of 60 or 80 check marks on a form? If a practitioner fails to check a particular procedure on the list and performs that procedure anyway, is the organization liable for a charge of corporate negligence? Did the organization review the applicant’s prior education, training, and experience for each privilege requested? These are all legal issues that are open for interpretation when using a laundry list privileging method.

Maintaining laundry lists is an extreme administrative and clinical nightmare. As new procedures or conditions are identified, the organization is required to update and maintain its laundry lists on an almost continuous basis.

This week's question and answer are from Core Privileges for AHPs, Second Edition, by Sally J. Pelletier, CPMSM, CPCS.
 

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