UPMC Delineation of Privileges Request Criteria Summary Sheet

UPMC

Delineation of Privileges Request

Criteria Summary Sheet

Facility: Children’s Hospital of Pittsburgh of UPMC

Specialty: PEDIATRIC MEDICINE

TRAINING/EDUCATION/BOARD STATUS

MD or DO or equivalent International degree

Completion of a three (3) year pediatric or family medicine residency program approved by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA) or equivalent foreign training.

Must be American Board certified in the area of their specialty by the appropriate ABMS or AOA accredited board within five (5) years of becoming eligible to sit for the examination. *Exceptions may be considered in unusual circumstances with approval of the division chief, department chairman, Credentials and Medical Executive committees.

VOLUME/EXPERIENCE General Pediatric Core: Initial: Required previous experience: The applicant must demonstrate by means of a case/procedure log the successful management of at least twenty-four (24) pediatric/and or newborn cases in the past 24 months of active clinical practice. Experience garnered in training may be included. Reappointment: Reappointment shall be based on objective results of care according to existing quality of care mechanisms; activity must comply with the Professional Staff Bylaws.

Applicant must demonstrate that they have maintained competence by verifying to the satisfaction of the division chief that they have managed twenty-four (24) pediatric and/or newborn cases in the past 24 months – either inpatient or outpatient office.

30 Category I CME’s (five (5) must be patient safety/risk management related) All CME’s must be within the past 24 months).

Special Privileges In order to be granted special privileges upon initial/reappointment an applicant must have performed at least five (5) of each of the following requested procedures during the past twelve (12) months. Procedures must be documented by a case/procedure log.

Tympanocentesis Skin Biopsy Procedural Sedation (Performed at least 20 in the past 24

months) – One of the following certifications required – PALS, ATLS, and/or ACLS

ADOLESCENT MEDICINE TRAINING/EDUCATION/BOARD STATUS


Pediatric/Family Medicine/Internal Medicine/Obstetrics/Gynecology Residency

Two (2) or Three (3) year Adolescent Medicine Fellowship

Initially board certified in Pediatrics, Family Medicine, or Internal Medicine

Individuals who have had extensive experience in adolescent medicine or have a specific area of expertise (e.g.; Ob/Gyn, Toxicology, Sports Medicine, Psychiatry, etc.) may qualify with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.

Ongoing board certification in Adolescent Medicine, OB/GYN, or Emergency Medicine.

VOLUME/EXPERIENCE Initial: Required previous experience: The applicant must demonstrate by means of a case/procedure log the successful management of 300 Adolescent Medicine and/or 100 Adolescent Gynecology cases in the past 24 months. Reappointment: 50 Adolescent Medicine and/or 100 Adolescent Gynecology cases in the past 24 months.

30 Category I CME’s – (five (5) must be patient safety/risk management related. All CME’s must be within the past 24 months).

Special Privileges

Colposcopy with or without biopsy (Performed at least 20 in the past 24 months)

Cryotherapy (Performed at least 5 in the past 24 months) Gynecological tissue biopsies (Performed at least 10 in the

past 24 months) IUD insertion and removal (Performed at least 10 in the past

24 months)

Subcutaneous contraceptive implant insertion and removal (Performed at least 10 in the past 24 months)

Procedural Sedation (Performed at least 20 in the past 24 months) – One of the following certifications required – PALS, ATLS, and/or ACLS

Gynecologic surgery, to include laparoscopy, treatment of ovarian diseases, uterine/cervical disease, vulvar disease (to include laser of vulva), and laparotomy for gynecological problems. If patient requires admission for post-operative care, he/she must be admitted to the service of a surgeon on the Active Medical Staff (Board certified or Board qualified in OB/GYN)

Toxicology (Performed at least 20 adolescent medicine cases in the past 24 months)

ALLERGY/IMMUNOLOGY/INFECTIOUS DISEASE



Pediatric/Internal Medicine Residency

Initially, Board certified in Pediatrics or Internal Medicine

Ongoing board certification in Allergy and Clinical Immunology

VOLUME/EXPERIENCE Initial: 200 Pediatric Allergy/Immunology cases in the past 24 months Reappointment: 200 Pediatric Allergy/Immunology cases in the past 24 months


Special Privileges Epicutaneous, intradermal & patch skin tests (Performed at

least 50 in the past 24 months) Interpret methacholine and specific antigen provocation

challenge tests and/or supervise, dispense and administer allergenic extracts (Performed at least 2 in the past 24 months)


BEHAVIORAL HEALTH


Psychology Core: Ph.D, or Psy.D or equivalent International degree

Completion of a Doctoral degree in Psychology (or a closely related area) by an accredited program

Psychologist must be licensed, which includes a passing grade on the National Psychology Licensing Exam (EPPP, Examination of the Professional Practice of Psychology), and a passing grade under the direct supervision of an experienced licensed psychologist.

VOLUME/EXPERIENCE

Initial: The applicant must demonstrate by means of a clinical log the successful management of at least 24 pediatric psychology cases in the past 24 months. Experience garnered during training may be included. Reappointment: 24 pediatric psychology cases in the past 24 months.



Neuropsychology Core: PhD, or PsyD or equivalent International degree

Completion of a Doctoral degree in an accredited program and completion of a 2-year postdoctoral fellowship in an Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) program or at another equally qualified postdoctoral training site. Training must contain a specific pediatric component that includes assessment, diagnosis, and treatment planning.

Neuropsychologist must be licensed, which includes a passing grade on the National Psychology Licensing Exam (EPPP, Examination of the Professional Practice of Psychology), and a passing grade under the direct supervision of an experienced licensed psychologist. Board certification by the American Board of Professional Psychology (ABPP) is encouraged.

VOLUME/EXPERIENCE Initial: The applicant must demonstrate by means of a clinical log the successful management of at least 24 pediatric neuropsychology cases in the past 24 months. Experience garnered during training may be included. Reappointment: 24 pediatric neuropsychology cases in the past 24 months.

30 Category I CME’s - five (5) must be patient safety/risk

management related. All CME’s must be within the past 24

months.

Special Privileges Hypnotherapy (Performed at least 12 in the past 24 months)

CARDIOLOGY



Pediatric/Med-Peds Residency

Pediatric Cardiology Fellowship

Initially board certified in Pediatrics

Ongoing board certification in Pediatric Cardiology

Individuals certified in adult Cardiology who have had extensive experience in Pediatric Cardiology or have a specific

area of expertise (e.g.; cardiac mapping, cardioversion, interventional procedures) may qualify with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.

VOLUME/EXPERIENCE Initial: 300 Pediatric Cardiology cases in the past 24 months Reappointment: 100 Pediatric Cardiology and/or Cardiac catheterization in the past 24 months.


Special Privileges Cath/Interventional

Diagnostic cardiac catheterization (Initial: Performed at least 100 catheterization cases in the past 24 months – Reappointment: Performed at least 20 catheterization cases in the past 24 months)

Interventional cardiac catheterization (Initial: Performed at least 30 catheterization cases in the past 24 months – Reappointment: Performed at least 15 catheterization cases in the past 24 months)

Placement of umbilical artery/vein catheter (Initial: Performed at least 6 in the past 24 months - Reappointment: Performed at least 2 in the past 24 months

Endomyocardial biopsy (Initial: Performed at least 10 in the past 24 months - Reappointment: Performed at least 5 in the past 24 months

Non-Invasive Imaging Transesophageal Echocardiogram (Initial: Performed at least

50 in the past 24 months - Reappointment: Performed at least

15 in the past 24 months

Fetal Echocardiography (Initial: Performed at least 10 in the past 24 months - Reappointment: Performed at least 5 in the past 24 months

Transthoracic Echocardiography (TTE) (Initial: Performed at

least 50 in the past 24 months - Reappointment: Performed at

least 15 in the past 24 months

Electrophysiology Radiofrequency ablation (Initial: Performed at least 10 in the

past 24 months - Reappointment: Performed at least 5 in the past 24 months

Pacemaker Insertion (Initial: Performed at least 10 in the past 24 months - Reappointment: Performed at least 5 in the past 24 months

Miscellaneous Procedural Sedation (Performed at least 20 in the past 24


CHILD ADVOCACY



Pediatric Residency

Fellowship program in Forensic Pediatrics or GME program in Emergency Medicine, Child Development, or Infectious Disease


Ongoing board certification in Pediatrics

VOLUME/EXPERIENCE Initial: 25 child maltreatment cases of variable type in the past 24 months Reappointment: 25 child maltreatment cases of variable type in the past 24 months


Special Privileges Anoscopy (Performed at least 25 in the past 24 months) Colposcopy (Performed at least 25 in the past 24 months) Completion of forensic rape kit (Performed at least 12 in the

past 24 months) Pelvic or genital exam under anesthesia (Performed at least

2 in the past 24 months) Removal of foreign body from vagina and/or anus

(Performed at least 2 in the past 24 months)

CRITICAL CARE MEDICINE



Pediatric Residency

PCC fellowship in Pediatric CCM, or Pediatric Cardiology plus one additional year of Critical Care Medicine, for those with practice limited to Pediatric Cardiac Critical Care


Ongoing board certification in Pediatric Critical Care Medicine

Individuals certified in Internal Medicine, Anesthesiology or Pediatric Surgery and who have had extensive training or experience in Pediatric Critical Care Medicine may qualify with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.

VOLUME/EXPERIENCE Initial: 200 Pediatric Critical Care cases in the past 24 months Reappointment: 150 Pediatric Critical Care cases in the past 24 months


Special Privileges *Initial/Reappointment – Performed at least 50 combined “Special” privileges listed in the column titled “Special Privileges” in the past 24 months

Consultative services and admitting privileges for all pediatric patients admitted who require critical care

Airway management, including endotracheal Central venous access (percutaneous or by cutdown) Arterial access (percutaneous or by cutdown) Pulmonary arterial catheter placement (percutaneous or by

cutdown) Initiation and management of mechanical ventilation,

including high frequency ventilation Placement of thoracostomy tubes Placement of pericardiocentesis tubes Placement of paracentesis tubes Initiation and management of vasoactive and/or

antiarrhythmic drug administration Management of patients on extracorporeal membrane

oxygenation (ECMO) Management of continuous renal replacement therapy

(CRRT) Management of elevated intracranial pressure Administration and management of intermittent and

continuous sedation, analgesia, and intravenous anesthetics, for management of critically ill patients, as well as for procedural and deep sedation

General management of single and multiple organ failures, including but not limited to shock, respiratory failure, coma, renal failure, hepatic failure, coagulopathy

Management of cardiopulmonary resuscitation Command physician responsibilities for critical care

transport

DERMATOLOGY



Initially board certified in Dermatology

Ongoing board certification in Pediatric Dermatology

VOLUME/EXPERIENCE Initial: 100 Pediatric Dermatology cases in the past 24 months Reappointment: 50 Pediatric Dermatology cases in the past 24 months.


Special Privileges Anesthesia, local (Performed at least 1 in the past 24 months) Biopsy (Performed at least 1 in the past 24 months) Biopsy, knife surgery (Performed at least 1 in the past 24

months) Cryosurgery (Performed at least 1 in the past 24 months) Electrosurgery (Performed at least 1 in the past 24 months)

Procedural Sedation (Performed at least 20 in the past 24


DEVELOPMENTAL/BEHAVIORAL TRAINING/EDUCATION/BOARD STATUS


Initially board certified in Pediatrics, Internal Medicine, and/or Family Medicine

Ongoing board certified in Developmental/Behavioral Pediatrics or Neurodevelopmental Disabilities

Individuals certified in an adult specialty who have a particular interest and experience in Developmental and/or Behavioral Medicine may treat and consult within specifically requested areas (e.g.; adults with Down Syndrome in the clinic setting) with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.

VOLUME/EXPERIENCE Initial: 100 Developmental/Behavioral Pediatric cases in the past 24 months Reappointment: 50 Developmental/Behavioral Pediatric cases in the past 24 months


Special Privileges Procedural Sedation (Performed at least 20 in the past 24


EMERGENCY MEDICINE



Initially board certified in Pediatrics or Emergency Medicine

Ongoing board certification in Emergency Medicine or Pediatric Emergency Medicine

Completion of Emergency Medicine Residency or Pediatric Residency

Completion of Pediatric Emergency Medicine Fellowship

Current ACLS Certification

Initial Appointment Only: ATLS Certification

VOLUME/EXPERIENCE Initial: 360 Pediatric Emergency Medicine cases in the past 24 months Reappointment: 240 Pediatric Emergency Medicine cases in the past 24 months

One-hour education session conducted annually by the Pediatric Emergency Medicine trauma liaison, OR, complete

48 hours of trauma related external CME in three (3) years; twelve (12) must be pediatric trauma related. These trauma credits may be applied to the thirty (30) Category 1 CME requirements.


Special Privileges

Management of Toxicology (Performed at least 12 in the past 24 months)


ENDOCRINOLOGY & DIABETES TRAINING/EDUCATION/BOARD STATUS


Pediatric, Internal Medicine, or Family Medicine Residency

Initially board certified in Pediatrics or Internal Medicine

Ongoing board certification in Pediatrics Endocrinology VOLUME/EXPERIENCE Initial: 20 Pediatric and/or Adolescent Weight Management and

Wellness cases in the past 24 months. Reappointment: 20 Pediatric and/or Adolescent Weight Management and Wellness cases in the past 24 months.

30 Category I CME’s - five (5) must be patient safety/risk management related. All CME’s must be within the past 24 months.

Special Privileges


GASTROENTEROLOGY




Pediatric Gastroenterology Fellowship


Ongoing board certification in Pediatric Gastroenterology

Individuals certified in Adult Gastroenterology who have had extensive experience in Pediatric Gastroenterology or have a specific area of expertise (e.g.; ERCP) may qualify with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.

VOLUME/EXPERIENCE

Initial: 200 inpatient and/or outpatient Pediatric Gastroenterology cases in the past 24 months.

Reappointment: 50 inpatient and/or outpatient Pediatric Gastroenterology cases in the past 24 months.


Special Privileges *Initial/Reappointment – Performed at least 70 combined “Special” privileges listed in the column titled “Special Privileges” in the past 24 months with the exception of ERCP. UPPER ENDOSCOPY

EGD with variceal sclerotherapy or banding EGD for control of hemorrhage EGD with dilation of esophageal stricture or achalasia Endoscopy with percutaneous gastrostomy tube

placement (PEG) Endoscopy with conversion of gastrostomy tube to jejunal

tube Enteroscopy for control of hemorrhage (via upper

endoscopy) Ileoscopy through stoma for control of Hemorrhage

Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP, diagnostic (Performed at least 20 in the past 24

months) ERCP, therapeutic (Performed at least 20 in the past 24

months) Lower Endoscopy

Colonoscopy with or without biopsy Colonoscopy with polypectomy Colonoscopy for control of hemorrhage

Therapeutic Colonoscopy Dilatation of strictures

Motility and pH Probe Studies Esophageal manometry Antroduodenal motility Colonic motility Anorectal manometry

Miscellaneous Procedures Percutaneous liver biopsy Paracentesis Procedural Sedation (Performed at least 20 in the past 24


HEMATOLOGY/ONCOLOGY




Pediatric Hematology/Oncology and Bone Marrow Transplantation Fellowship


Ongoing board certification in Pediatric Hematology/Oncology

Individuals certified in Adult Hematology/Oncology and Bone Marrow Transplantation who have had extensive experience in Pediatric Hematology/Oncology and Bone Marrow Transplantation or have a specific area of expertise (e.g.; stem cell transplantation) may qualify with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.

VOLUME/EXPERIENCE Initial: 150 Pediatric Hematology/Oncology & Bone Marrow Transplantation cases in the past 24 months Reappointment: 150 Pediatric Hematology/Oncology & Bone Marrow Transplantation cases in the past 24 months


Special Privileges *Initial/Reappointment – Performed at least 25 combined “Special” privileges listed in the column titled “Special Privileges” in the past 24 months. Percutaneous Biopsy

Bone Marrow Skin

Aspiration Bone Marrow Thoracentesis Paracentesis Joint

Catheterization Percutaneous Arterial Line Placement Percutaneous Catheterization of Veins

Miscellaneous Procedures

Bone Marrow Harvesting Bone Marrow Transplantation Lumbar Puncture Administer IT Chemotherapy Ordering of Exchange Transfusion Order/monitor Chemotherapy PCA Management Procedural Sedation (Performed at least 20 in the past 24


INFECTIOUS DISEASES TRAINING/EDUCATION/BOARD STATUS


Pediatric or Internal Medicine Residency

Pediatric Infectious Diseases Fellowship Individuals certified in Adult Infectious Diseases who have

had extensive experience in Pediatric Infectious Diseases may qualify with the approval of the Division Chief, Department Chair, Credentials and Medical Executive Committees.


Ongoing board certification in Pediatric Infectious Diseases VOLUME/EXPERIENCE Initial: 100 Pediatric Infectious Diseases cases in the past 24 months.

Reappointment: 100 Pediatric Infectious Diseases cases in the past 24 months.


MEDICAL GENETICS



Pediatrics/Clinical Medical Genetics residency or clinical Medical Genetics fellowship

Initially board certified in Clinical Genetics

Ongoing board certification in Clinical Genetics

VOLUME/EXPERIENCE Initial: 125 Pediatric Medical Genetic cases in the past 24 months. Reappointment: 100 Pediatric Medical Genetic cases in the past 24 months.


Special Privileges Gene therapy for management of an inborn error of

metabolism (Performed at least 10 in the past 24 months) Skin Biopsy (Performed at least 10 in the past 24 months)

NEONATOLOGY


MD or DO or equivalent International degree WELL BABY CORE:

Pediatric or Family Residency


Ongoing board certification in Pediatrics MD or DO or equivalent International degree WELL NEWBORN CARE CORE:

Pediatric or Family Residency


Ongoing board certification in Pediatrics MD or DO or equivalent International degree

NEWBORN HOSPITALIST CORE

Pediatric Residency


Ongoing board certification in Pediatrics MD or DO or equivalent International degree NEONATOLOGY

Pediatric Residency

Neonatology Fellowship


Ongoing board certification in Neonatology

VOLUME/EXPERIENCE

WELL BABY CORE & WELL NEWBORN CARE CORE Initial: 20 newborn cases in the past 24 months. Reappointment: 20 newborn cases in the past 24 months.


NEWBORN HOSPITALIST CORE Initial: 20 neonatal cases in the past 24 months. Reappointment: 20 neonatal cases in the past 24 months.


NEONATOLOGY Initial: 20 neonatal cases in the past 24 months. Reappointment: 20 neonatal cases in the past 24 months.


Special Privileges Management of patients on extracorporeal membrane

oxygenation (ECMO) (Requires formal training and 2 years of collaborative experience – Performed at least 5 in the past 24 months.)

Management of Continuous Renal Replacement Therapy (Performed at least 5 in the past 24 months)

Procedural Sedation (Performed at least 20 in the past 24 months) – NRP Course Certificate required

NEPHROLOGY



Pediatric or Internal Medicine Residency

Pediatric Nephrology subspecialty fellowship program

Individuals certified in Adult Nephrology who have had extensive experience in Pediatric Nephrology or who have a specific area of expertise (e.g. focal glomerulosclerosis) may qualify with the approval of the Division Chief, Department Chair


Ongoing board certified in Pediatric Nephrology

VOLUME/EXPERIENCE Initial: 200 Pediatric Nephrology cases in the past 24 months. Reappointment: 200 Pediatric Nephrology cases in the past 24 months.


Special Privileges Percutaneous renal biopsy (Performed at least 10 in the past

24 months) Bladder catheterization (Performed at least 10 in the past 24

months) Procedural Sedation (Performed at least 20 in the past 24


NEUROLOGY



Pediatric or Neurology Residency

Initially board certified in Neurology

Ongoing board certification in Neurology with special qualifications in Child Neurology

VOLUME/EXPERIENCE Initial: 200 Child Neurology cases in the past 24 months. Reappointment: 150 Child Neurology cases in the past 24 months.


Special Privileges Electromyography, perform (Performed at least 10 in the

past 24 months) Performing Ultrasound based Transcranial Doppler

Monitoring (Performed at least 10 in the past 24 months) Botox Injection (Performed at least 10 in the past 24 months) Needle Muscle Biopsy (Performed at least 10 in the past 24

months) Procedural Sedation (Performed at least 20 in the past 24


PULMONOLOGY



Pediatric Residency

Pediatric Pulmonology Fellowship


Ongoing board certification in Pediatric Pulmonology

VOLUME/EXPERIENCE Initial: 200 Pediatric Pulmonology cases in the past 24 months. Reappointment: 200 Pediatric Pulmonology cases in the past 24 months.


Special Privileges

Bronchoscopy (Performed at least 10 in the past 24 months) Bronchoalveolar Lavage (Performed at least 5 in the past 24

months) Bronchial Biopsy (Performed at least 5 in the past 24 months) Transbronchial Biopsy (Performed at least 5 in the past 24

months)

Polysomnogram interpretation (Performed at least 50 in the past 24 months)

Pulmonary Function Testing and Interpretation with sedation (Performed at least 5 in the past 24 months)

Pulmonary Function Testing and Interpretation w/o sedation (Performed at least 5 in the past 24 months)

Interpret methacholine and specific antigen provocation challenge tests and/or supervise, dispense and administer allergenic extracts (Performed at least 5 in the past 24 months)

Exercise testing (Performed at least 5 in the past 24 months) Procedural Sedation (Performed at least 20 in the past 24


PEDIATRIC SLEEP MEDICINE



Pediatric Pulmonology, Neurology, Sleep Medicine, or Family Medicine fellowship

Initially board certified in Pediatrics, Neurology, Sleep Medicine or Family Medicine

Ongoing board certification in Pediatrics, Neurology, Sleep Medicine or Family Medicine

VOLUME/EXPERIENCE Initial: 50 procedures in the past 24 months. Reappointment: 50 procedures in the past 24 months.


RHEUMATOLOGY



Pediatric or Internal Medicine residency

Rheumatology or Pediatric Rheumatology subspecialty fellowship

Training program must have at least 35% pediatric component or current practice must consist of at least 33% pediatric patients.


Ongoing board certification in Rheumatology or Pediatric Rheumatology

VOLUME/EXPERIENCE Initial: 100 Pediatric Rheumatology cases in the past 24 months. Reappointment: 100 Pediatric Rheumatology cases in the past 24 months.




WEIGHT MANAGEMENT AND WELLNESS



Pediatric, Internal Medicine, or Family Medicine residency


Ongoing board certification in Pediatrics, Internal Medicine, or Family Medicine

VOLUME/EXPERIENCE Initial: 20 Pediatric and/or Adolescent Weight Management and Wellness cases in the past 24 months. Reappointment: 20 Pediatric and/or Adolescent Weight Management and Wellness cases in the past 24 months.




UPMC Delineation of Privileges Request Criteria Summary Sheet

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