Guidelines for Credentialing and Delineation of Clinical Privileges in Emergency Medicine

This Policy Resource and Education Paper is an explication of the Policy Statement Physician Credentialing and Delineation of Clinical Privileges in Emergency Medicine.

June 2006

The American College of Emergency Physicians has developed the following guidelines to assist individuals and institutions in creating application procedures for hospital medical staff appointments in the department of emergency medicine (credentialing), plus delineation of clinical privileges in emergency medicine (privileging).

These guidelines are not a substitute for any hospital medical staff application/reassessment processor for any legislative, judicial, or regulatory body mandates.

Credentialing

Figure 1 suggests criteria for appointment and reappointment. The medical director must meet the same criteria as other department members. If a medical director's initial appointment or reappointment is in question or disputed, an option is to refer the matter to the hospital's credentials committee, or to the medical executive committee for adjudication.

Delineation of Clinical Privileges

Figure 2 provides a sample form for request of general privileges in emergency medicine and a checklist for specific procedures. These criteria and forms are presented only as guidelines and are not intended to set a standard for any institution or to be all-inclusive.

The emergency department medical director is responsible for setting competence criteria utilizing input from department members. He is also ultimately responsible for determining the competence of individual department members.

The medical director must also be in compliance with established department proficiency and competence criteria. In the event of question or dispute over the medical director's competency, the matter may be referred to the medical staff's credentials committee or to the medical executive committee.

Establishing criteria for proficiency and the evaluation of proficiency may be problematic. For those medical specialties that perform major procedures (eg, cardiovascular surgery), establishing numerical thresholds may be valid (ie, requiring that a minimal number of procedures be performed during the privileging period under review).

However, for those specialties that are primarily "cognitive" in nature, and which employ a wide armamentarium of "minor" procedural skills, establishing numerical thresholds for numerous procedures may be very difficult to track. Further, it is not clear whether such tracking of "minor" procedural skills is a valid component of proficiency assessment.

Many emergency departments will choose to establish clinical privileges assessment methodologies that utilize a combination of procedure tracking (frequency), plus assessment based on sentinel events and information forthcoming from the department's overall quality improvement plan.

Establishing frequency thresholds in emergency medicine may be problematic. Certain procedures may be performed very rarely (eg, cricothyrotomy). Yet, all emergency physicians must be capable of performing this and several other rarely-performed emergency procedures.

In the event that a member does not meet or exceed numerical thresholds for procedures when such thresholds have been set, an option is to extend a physician's procedure privileges through a "skills lab" (eg, educational review, demonstration, and/or testing).

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