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Take a proactive approach to 'new' privileges

Credentialing Resource Center Connection, September 18, 2003

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Dear Credentialing Colleague:

This week, I'll address the large number of questions I've received regarding privileges for bariatric surgery (a.k.a. "stomach stapling" for weight loss). Medical staff services professionals, medical staff leaders, CEOs, insurance company representatives, and even performance improvement directors have submitted queries.

As always, the first time you receive a request for bariatric surgery privileges should not be the first time you've thought about this issue. The best position a hospital can put itself in is to define in advance its stance on this procedure. It must first ask, "Will we permit the performance of baratric surgery at all?" (In other words, will the hospital offer it as a service to the community, or will it refer patients to other appropriate facilities?)

Because this kind of decision is not a credentialing issue, I'll address it no further. If, however, the answer to the first question above is "Yes, we should offer this service to the community!" it most definitely becomes a credentialing issue that requires the development of a hospital policy. Medical staff leaders must precisely define the amount of education, training, and experience necessary to carry out bariatric surgery. Augment the policy with rules that all privileged physicians must follow in order to exercise this new privilege. For example,

- agree to work as a team member within the bariatric surgery program
- agree to work under the direction of the bariatric surgery medical director
- agree to follow the institution's clinical guidelines for bariatric surgery
- agree to use the bariatric surgery informed decision program (an advanced version of informed consent)
- agree to participate in the bariatric surgery case presentation and continuing medical education (CME) programs established in conjunction with the CME director
- understand the need for enhanced documentation of the credentialing decisions that lead to the granting of clinical privileges

As you can see, the development of a bariatric surgery program is much more complicated than simply granting privileges to a qualified physician. The risks to the patient, physician, and institution are simply too great. Take steps that will minimize the likelihood that injury or misperceptions will lead to litigation.

That's all for this week.

All the best,

Hugh Greeley

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