Guidelines For Institutions Granting Ultrasonography Privileges To Surgeons

I. PRINCIPLES OF CREDENTIALING

PREAMBLE

The society of American Gastrointestinal Endoscopic Surgeons (SAGES) recommends the following guidelines for privileging qualified surgeons in the performance of ultrasound (transabominal, laparoscopic, endoscopic, thoracoscopic surgery, and endovascular). The basic premise is that the surgeon(s) must have the judgment and training to perform ultrasonography safely and accurately interpret the findings.

A. PURPOSE

The purpose of this statement is to assist hospital credentialing committees in their task of granting privileges to surgeons for the performance of ultrasonography (transabdominal, laparoscopic, endoscopic, intraoperative, thoracoscopic and endovascular) for diagnostic and therapeutic purposes. In conjunction with the standard JCAHO guidelines for granting hospital privileges, implementation of these methods should help to insure that ultrasonography performed by surgeons is performed only by individuals with appropriate competency, thus assuring optimal patient care and procedure utilization.

B. UNIFORMITY OF STANDARDS

Uniform standards should be developed by the credentialing committee which are applicable to all surgeons requesting privilege to perform ultrasonography. Criteria must be established which are medically sound, and not unusually stringent, taking into account the skills that a surgeon already possesses as part of his/her surgical training.

C. SPECIFICITY OF PRIVILEGING FOR ULTRASONOGRAPHY

Privileges should be granted for each major category of ultrasonography separately. The ability to perform one ultrasonographic procedure does not automatically imply adequate competency to perform another. Associated skills generally considered to be an integral part of an ultrasonographic category may be required before privileges for that category can be granted.

D. RESPONSIBILITY FOR CREDENTIALING

The credentialing structure and process are the responsibility of each hospital. It should be the responsibility of the Department of Surgery, through its’ Chief to recommend individual surgeons for privileges in ultrasonography as for all other procedures performed by members of his/her department.

II. MINIMUM REQUIREMENTS FOR GRANTING PRIVILEGES

Part II A is mandatory, and must be accompanied by either part II B, II C, or at least one component of part II D.

A. FORMAL FELLOWSHIP OR SURGICAL RESIDENCY TRAINING

Prerequisite training must include satisfactory completion of an accredited surgical residency program, with subsequent certification by the American Board of Surgery as required by the institution. The residency program must be accredited by the Accreditation Council for Graduate Medical Education or the equivalent body if the program is based outside the United States or Canada.

B. FORMAL TRAINING IN ULTRASONOGRAPHY

For surgeons who successfully completed a residency and/or fellowship program that incorporated a structured experience in ultrasonography, the applicant’s program director, and if desired other faculty members, should supply the appropriate documentation of training.

C. NO FORMAL RESIDENCY TRAINING IN ULTRASONOGRAPHY

For those surgeons without residency and/or fellowship training, which included structured experience in ultrasonography, or without documented prior experience in these areas, a structured training curriculum is required. The curriculum should be defined by the institution, and may include a formal course. The curriculum should include an appropriate number of opportunities for the applicant to observe, assist, and serve as primary operator for the procedure for which privileges are being sought. The curriculum should include didactic sessions and hands-on experience with inanimate and/or animate models. Other teaching aids may include video review and interactive computer programs.

D. PRACTICAL EXPERIENCE

1. Applicant’s Experience – Documented experience that includes an appropriate volume of cases equivalent to the procedure in question in terms of complexity. The chief of surgery should determine the appropriateness of this experience.
2. Experience with Preceptor and/or Proctor - The specific role and qualifications of the preceptor and/or proctor, if required, must be determined by the institution. Criteria of competency for each procedure should be established in advance, and should include evaluation of: familiarity with instrumentation and equipment, competence in their use, appropriateness of patient selection, safety, and successful completion of the procedure. The criteria should be established by the chief of surgery in conjunction with the specific specialty chief where appropriate. It is essential that proctoring be provided in an unbiased, confidential, and objective manner.

III. MAINTENANCE OF PRIVILEGES

A. PROVISIONAL PRIVILEGES

Once competence has been determined, a period of provisional privileges may be appropriate. The time frame and/or number of cases required during this period should be determined by the chief of surgery and/or the appropriate institutional committee, board, or governing body.

B. MONITORING OF ULTRASONOGRAPHIC PERFORMANCE

To assist the hospital credentialing body in the ongoing renewal of privileges, there should be a mechanism for monitoring each surgeon’s performance. This should be done through existing quality assurance mechanisms or an appropriate hospital committee. Monitoring may include ultrasound utilization, image quality, diagnostic and therapeutic benefits to patients, complications, and tissue review in accordance with previously developed criteria.

C. RENEWAL OF PRIVILEGES

For renewal of privileges an appropriate level of continuing clinical activity should be required, in addition to satisfactory performance as assessed by monitoring of procedural activity through existing quality assurance mechanisms. Continuing education related to ultrasonography should be part of the periodic renewal of privileges.

D. DENIAL OF PRIVILEGES

Institutions denying, withdrawing, or restricting privileges should have an appropriate mechanism for appeal in place. The procedural details of this should be developed by the institution, and must satisfy the institution’s bylaws and JCAHO recommendations.

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Society of American Gastrointestinal Endoscopic Surgeons
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Los Angeles, CA 90064
(310) 437-0544
FAX: (310) 437-0585
E-mail: sagesweb@sages.org

SAGES publication #0020

 

 

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