Privileging Criteria

Additional criteria (beyond what is described in privilege forms) that must be met in order to be granted some specialized privileges.

Bronchial Thermoplasty

Fluoroscopy                                       

Lapa- & Hyste- roscopic Morcellation       

Moderate Sedation       

Port Access Catheter Placement                        

Robotic Surgery

Transoral Incisionless Fundoplication

Uterine Prolapse Procedures

Ventilator Management

Xtreme Lateral Interbody Fusion (XLIF)

Details of Proctoring expectations coming soon...


Bronchial Thermoplasty

Initial Application Criteria - Manufactures training requirements for The Alair® Bronchial Thermoplasty System from Boston Scientific

Bronchial thermoplasty training will be required:

  • Review of Catheter Instructions for Use and Controller Operator’s Manual
  • Guided didactic instruction in computer simulation-based Bronchial Thermoplasty Learning Center
  • Detailed in-service training of the Alair® System
  • Hands-on training with Alair® System in a lung model prior to initial cases
  • Proctoring of initial cases by Asthmatx Health Care Industry Representative (HCIR)

Ongoing support of cases when requested

 

Fluoroscopy

Complete this training, print the certificate and include it with your application materials.

 

Laparoscopic and Hysteroscopic Morcellation

Initial Application Criteria –

Documentation of formal training in Residency

OR

Completion of manufacturer's Morcellator course

AND

Physician proctor must be present for a minimum of the first three procedures

AND

Equipment manufacturer's representative must be present for a minimum of the first three procedures

 

Moderate Sedation 

  1. Completion of the sedation self-study packet, including post-test with a passing score of 85%.
  2. Provide evidence of current ACLS certification with an included airway management module
    OR
    Completion of an approved Airway Management Skills Lab, including hands-on practice with OPAs, LMA and ET intubation on airway simulators.
  3. Provide evidence of current PALS certification if practice will include children/infants/newborns.


Port Access Catheter Placement in Minimally Invasive Cardiac Surgery

Initial Application Criteria - MUST hold TEE Privileges; completion of equipment manufacturer’s didactic in-service training session followed by surgical case training with catheter placement in familiar open chest procedures; equipment manufacturer’s representative present for first 3 minimally invasive procedures.

 

Robotic Surgery

Initial Application Criteria -

  1. Must posess privileges to perform the same procedure open and/or laparoscopically.
  2. If residency/fellowship training was completed within the past three years a letter from the program director stating that applicant is qualified to perform the requested procedures utilizing da Vinci Surgical System is required. The applicant must also submit a case log of at least five (5) cases performed within the past 12 months.
  3. If residency/fellowship training was completed greater than three years ago a letter from the appropriate hospital department chair stating the applicant is qualified to perform the requested procedure utilizing the da Vinci Surgical System is required. The applicant must also submit case log of at least five (5) cases, performed within the past 12 months.
  4. In the absence of formal training in a residency or fellowship, surgeons requesting this privilege must complete the Intuitive Surgical system training, including didactics as well as hands on simulation, usually with the porcine model.  In addition, observation of two (2) cases relevant to their specialty. 
  5. Once the above criteria are met the applicant is eligible to request the privilege and move to the Proctoring phase. Proctoring must include observation of four (4) cases by a physician with privileges to do the same robotic procedure. This proctor will be monitoring the procedure, as well as the use of the robotics. Qualified proctors will have performed a minimum of 20 robotic surgeries.
  6. Proctoring may be waived for those practitioners who can provide documentation of current robotic privileges, activity and outcomes from another facility.

Upon successful completion of these requirements the applicant will be allowed to do the robotic procedures without supervision.

Reappointment Appointment Criteria - Performance of ten (10) procedures during the previous reappointment cycle.  If the surgeon fails to meet the maintenance caseload, they must have cases proctored (at least 2) until again deemed proficient.

 

Transoral Incisionless Fundoplication                       

Initial Application Criteria –

Completion of equipment manufacturer's training course AND documentation by equipment manufacturer's representative/proctor of successful completion of a minimum of the first 3 cases;

OR

documentation of having performed a minimum of 10 TIF cases in the past 12 months.

 

Uterine Prolapse Procedures

Initial Application Criteria – Equipment manufacturer’s physician proctor must be present for the first 3 of each TVT and TOT procedures performed.

Documentation of completion of equipment manufacturer’s training course for each type of mesh procedure AND both equipment manufacturer’s representative and physician proctor must be present for the first 3 cases. 

 

Ventilator Management 

Watch video (in 3 parts) and complete attestation document.

 

Xtreme Lateral Interbody Fusion (XLIF)

Initial Application Criteria - Must complete equipment manufacturer’s training course including didactic instruction followed by hands-on cadaver lab

Reappointment Criteria - Current performance of procedure with acceptable outcomes

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