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Credentialing and the hidden risk of gastric bypass surgery

Credentialing Resource Center Connection, January 12, 2004

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Dear Credentialing Colleague:

Why is it that some hospitals seem to be "getting it right" when it comes to the establishment of gastric bypass programs, while so many other facilities are struggling? The answer is self evident.

Some hospitals and their medical staffs are genuine "learning organizations," while most are not. Last year, nearly 64,000 Americans chose to have gastric bypass surgery for weight loss. Dozens of well researched articles now suggest that the procedure is volume sensitive. Inexperienced surgeons do not achieve the excellent results achieved by their more experienced colleagues. What are the credentialing issues that must be considered in order to assist the institution in mounting a first-class program designed to minimize preventable mortality and complications?

As with so many other new or potentially dangerous procedures, the first consideration is strategic and has nothing to do with credentialing. Should your hospital offer this procedure to the community? If not, the issue is done, and the credentials committee need not concern itself further. If a decision is made to offer the procedure, the credentials committee should see to it that the criteria that must be met by a physician seeking this privilege should be the very highest. No weekend courses should qualify any physician to perform this complicated procedure.

Consensus suggests that gastric bypass surgery requires a significant training period. Many bypass programs have no "proctoring" requirement for gastric bypass, whatsoever. According to Jeffery Peters, MD, a laparoscopic surgeon at the University of Southern California University Hospital, as quoted in the January 4 "Boston Globe" (http://www.boston.com), "every surgeon should be proctored for 40 to 50 cases."

The job of a credentials committee is first to protect the patient. This is done through the establishment and use of strict criteria for granting privileges, appropriate proctoring or co-management requirements, and the most sophisticated peer review/quality monitoring program available.

Second, the job of a credentials committee is to assist physicians to practice within the community. Hospitals should let physicians know what the standards are in advance.

And third, a credentials committee must protect the institution from embarrassment, and legal or regulatory challenges. This is done through careful documentation and thoughtful precise implementation.

That's it for this week.

All the best,

Hugh Greeley

http://www.greeley.com/seminars/

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