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Take a close look at privileging for bariatric surgery

Credentialing Resource Center Connection, April 1, 2004

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Dear credentialing colleague:

It is often said that a single unusual event does not constitute a pattern. Physicians also often comment that three or more such events is a pattern deserving of a full review and analysis. If this is true, then the issue of bariatric surgery now deserves a full and comprehensive credentials review. Within the last two weeks, five institutions have called requesting information concerning the granting of clinical privileges to perform this surgery. In each instance, physicians began performing this surgery without first: 

1.  Requesting clinical privileges

2.  Meeting the criteria for such privileges, or

3.  Meeting the requirements for proctoring or preceptorship

With this week's letter I am strongly recommending that all credentials committees request a thorough and comprehensive review of the privileging systems used within your institutions to authorize physicians to perform bariatric surgery. It is incumbent upon the credentials and medical executive committees to ensure that all physicians performing this "miraculous" surgery do so only after a positive determination has been made concerning their current clinical competence. The criteria generally recognized for the granting of bariatric surgical privileges are now quite well-known. All institutions should positively determine that their criteria are at least at the generally recognized level, if not higher.

It is possible that you may find one of the following situations:

1.  Physicians performing this work in a quality manner but without evidence that they have in fact applied for, been granted privileges, and then been monitored through a designated medical staff process. Under these circumstances, the medical staff credentials process should be immediately applied to such surgeons and positive evidence should be documented within their credentials files indicating that they possess adequate education, training, experience, and evidence of clinical competence justifying a grant of clinical privileges.

2.  Physicians performing this work with concern expressed by certain physician leaders about its quality and no evidence that they have met preestablished criteria for the granting of clinical privileges. Under these circumstances, any surgeon should be informed that they must cease performing such work until the credentials committee has had an opportunity to review their qualifications.

Under either circumstance, credentials committee members must recognize that the credentials process exists for three specific purposes: patient protection, to facilitate physician practice, and institutional protection. In the area of bariatric surgery, these three issues must be carefully considered by any reasonable credentials committee in those institutions that have authorized a bariatric surgical program.

That's it for today

All the best,

Hugh Greeley

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

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