Lightning rounds 61: Credentialing and privileging, with Christopher Newman

Podcast: Play in new window | Download

Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | TuneIn | RSS

We dive into the confusing rabbit hole of medical staffing, credentialing, and privileging, particularly for the critical care APP, with Chris Newman, pediatric critical care PA and Vice Chair for Clinical Performance at the University of Colorado.

Check out the REVIVE conference here!

Check out the CHEST Procedural Skills for the Critical Care Clinician course here!

Learn more at the Intensive Care Academy!

Takeaway pearls

1. The medical staff office regulates the medical staff, which includes physicians and APPs. The latter may actually be voiting “members” of the medical stuff, or have some kind of affiliate status; the relevance of this is their eligibility to vote and sit on its committees, which sets the policies and manages governance. Either way though, APPs are subject to the medical staff office’s regulation.
2. Credentialing is the process of ensuring medical staff have the right and competence to work in the hospital, mostly confirming basic job requirements like graduating training programs. Privileging is the process of determining what specific things you are allowed to do in the hospital.
3. Privileges are broken into core privileges, which are things any provider should know how to do (i.e. taught in school): perform H&Ps, order meds and tests, interpret them, etc. Special privileges are those that require additional training, usually procedures. Some of the latter may become core privileges over time.
4. Special privileges are needed for anything “infrequent and high risk,” which requires some judgment – i.e. if a procedure is not listed, does that mean you cannot do it, or that it does not even require special privileges? Which procedures are listed is determined by the judgment of the clinicians in medical staffing, and the list is not always perfect.
5. All of these processes are hospital based, usually not part of state law, and are also often subject to Joint Commission regulation. However your hospital handles them, it is expected to follow its own policies consistently.
6. Learners are managed under policies for proctoring, not privileges. A person with procedural privileges can generally supervise a learner without privileges to perform it; if that’s a student, it is considered to be “done” by the proctor, and if by a licensed provider without privileges, it is “done” by the learner under supervision. Such a learner may eventually obtain their own privileges (usually by meeting a requirement of either numbers or observed competence or both). The exact rules of how all this works is governed by a proctoring policy which can be looked up.
7. While many providers may feel it is accepted, or even an ethical obligation, to perform procedures they are trained but not privileged to perform in an emergency (i.e. to save a life when a privileged person is not immediately available), there is usually no explicit allowance for this in hospital policy, so buyer beware.
8. If you don’t like how your processes work, change them.