Clinical Privilege 26 Juli 2010

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CLINICAL PRIVILEGES Kewenangan yang diberikan kepada dokter, dokter gigi, perawat dan bidan oleh Hospital Governing Board atau Direktur RS untuk memberikan layanan kepada pasien di RS. Pemberian kewenangan tsb secara umum dibatasi hanya pada tenaga kesehatan yang memiliki lisensi, pengalaman dan kompetenkompetensi. si.

CLINICAL PRIVILEGES Emergency privileges perlu diberikan kpd setiap tenaga kesehatan ketika ada kondisi emergensi di RS, tanpa dikaitkan dengan tugas layanan reguler maupun statusnya. Temporary privileges bisa diberikan kepada tenaga kesehatan untuk memberikan layanan kesehatan dalam waktu terbatas atau kepada pasien spesifik.

PEMBERIAN CLINICAL PRIVILEGES Ada banyak metoda pemberian Clinical Privilege. Privilege. MasingMasing-masing metode punya kelebihan dan kelemahan atau punya keuntungan dan kerugian. Terdapat 4 metode pemberian CP, yaitu: 1. Laundry list method. 2. Categorical privilege delineation method. 3. Core privilege delineation method. 4. Combination approach. RS perlu mengkaji metode mana yg paling sesuai.

LAUNDRY LIST METHOD1. This method has been in use since the 1950s. 1950s. 2. To address issues related to inconsistent education and training of physicians. 3. It requires the facility to develop a list of all possible procedures a provider may perform for a specific type of specialty. 4. Advantages of this approach include the availability of a provider specific listing of approved procedures. 5. This is especially helpful for the surgical specialties. 6. The disadvantages of using this type of system are in the maintenance and updating of the procedure lists. lists.

Check List Clinical Privilege

CATAGORICAL PRIVILEGES 1. This method delineates clinical privileges in specific categories or levels of privileges. 2. The categories can be defined in many ways, such as by training and experience, patient types or diseases, major treatment areas and degree of complexity. 3. This approach works well for medical secialties.

CORE PRIVILEGES1. The concept of core privileges requires the medical staff to identify those cognitive and procedural skills that are part of the core competency of a given specialty. 2. This allows any physician meeting the requirements for requirements education, training and experience to perform any and all of the core privileges. 3. Special procedure privileges may be obtained by documenting additional training, experience and comcompetency for specific procedures requested. 4. Lists of specific diagnostic and invasive procedure skills must be developed for each set of core privileges.

COMBINATION APPROACH Components of any of the above methods can be combined to create a clinical privilege delineation method appropriate to a specific facility.

THE ULTIMATE RESULT The ultimate result of any method of clinical privilege privilege delineation is to insure the clinical competency of the medical staff. During the initial appointment process cliniclinical competency validation is accomplished by obtaining references related to requested obtaining clinical privileges and by verifying education, training and experience.

BAGAIMANA MENILAI KOMPETENSI 1. Board certification. certification. 2. Documentation of training and experience. experience. 3. Physicians may gain this training through supervised training programs. 4. Practitioner may also gain provisional privileges allowing him or her to perform the procedure under the supervision of another practitioner skilled in the proce-dure proce(proctoring).

5. Data from some new procedures have shown that the complication rate decreases significant-ly and significant competency increases significantly after a certain number procedures are performed. performed. 6. Guidelines for competency in new procedures or treatment modalities must be developed on the basis of a review of the literature and the technical aspects of the procedure. Once the guidelines are successfully met by the practitioner, full privileges are granted. 7. As new procedures and treatment modalities develop, guidelines for clinical privileges must also develop.

CREDENTIALING ASPECTS 1. Kompetensi Akademik: a. kognitif; dan b. Psikomotor. 2. Kesehatan: a. kesehatan fisik; dan b. kesehatan mental.

IMPAIRED PHYSICIANS The one is unable to practice medicine with reasonable skill and safety to patiens because of a physical or mental illness, including deterioration through the aging process or motor skill, or excessive use or skill, abuse or drugs.Joint Commission Credentialing, Privileging, Competency, and Peer Review, 2003 Review, 2003

INITIAL CREDENTIALING1. Licensure what type of license is required for the specific privilege, MD, DO, PA, NP? 2. Staff Category should the specific privilege be restricted to a specific category of medical staff: active, consulting, courtesy? 3. Training what specific training is required to perform each privilege specified? This component includes education, medical, dental, nursing, postgraduate residency, fellowship and in what specialties? Also included in this area could be the requirement of specific focused training and education related to the privilege such as a 10-hour 10course in the use of lasers.

4. Concurrent privileges. The standards must define any concurrent privileges that the provider must possess such as surgical privileges for open cases in addition to laparoscopic procedures. 5. Board certification/recertification requirements. Board certification indicates that an individual has demonstrated an understanding of a basic body of knowledge. If board certification is a requirement for a specific clinical privilege, then the criteria should also address the consequences of not maintaining board certification. 6. Preceptorship the standards should address whether or not a the specific clinical privilege may be obtained by participating in a Preceptorship and the qualifications of the preceptorship including training methods.

7. Continuing medical education requirements should be outlined for each specific clinical privilege for which there is a requirement for CME. 8. Required number of cases the specific minimum number requirement indicating the level of experience required to obtain clinical privileges for the requested procedure. 9. Reference letter - standards for privileges should include a requirement for reference letters from either the providers education program, or from the hospital Department Chair. The reference letter should assess the providers qualifications and competency to perform the specific clinical privileges requested. requested.

10. Proctoring/provisional requirements. For facilities with an adequate number of members on the medical staff to provide direct observation of the care provided, proctoring can provide good information on the level of skill and expertise of the provider. 10. Confirmation of a certain number of patients treated with a specific condition within a specified period of months. 10. Information from other facilities. If the request for privileges is the initial request, information on volume and competence must be obtained from the pervious practice site. The standards should address what information must be obtained from the previous facility.

RECRECENTIALINGCollect data on at least the following areas: 1. Number of procedures performed. performed. 2. Number and types of diagnoses managed. managed. 3. Outcomes achieved (complication rates, mortality rates, readmission rates). rates). 4. Results of review of required functions such as blood use, medication use, operative and invasive procedure review, medical record completion including legibility and timeliness and the results of performance improvement activities. activities. 5. Risk management information such as patient complaints, compliments, malpractice activity. activity. 6. Utilization review data such as length of stay, and resource utilization. utilization.

CONSIST OF THE CREDENTIALS REVIEW1. Ensure that all information in included in the packet for the credential committee and medical staff review. 2. Information in the packet includes quality and peer review data to support the requested clinical privileges. 3. Additional information is included to address any red flags such as liability insurance claims, discrepancies in information on the reappointment form.

MASA BERLAKUNYA CP Clinical privilege tidaklah bersifat permanen sehingga dapat: a. dipersempit; b. diperluas, melalui permohonan yang didukung oleh setifikat pendidikan atau pelatihan; atau c. dicabut berdasarkan alasan tertentu.