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PubMed1992

Research review: differentiation of roles and functions of medical record practitioners.

The purpose of this study was to determine whether the actual and appropriate roles and functions of medical record practitioners varied by credential, current position, years of medical record experience, and size of facility. The actual role describes what practitioners are currently doing in the workplace; the appropriate role describes what practitioners believe they should be doing in the workplace. For both the actual and appropriate roles, current position was the most discriminating variable, and credential was the least discriminating variable. Lack of discrimination is most likely due to the similarity in the professional components of medical record administration and medical record technician educational programs.

Analysis of Variance↗
PubMed1998

Doc accrediting goes high-tech.

Physician credentialing, an obscure but critical process that serves as the primary safeguard against poor care is undergoing a high-tech revolution. A handful of credentials verification organizations are bringing efficiency to the labor-intensive chore by consolidating most of the required data. Technology can expedite physician approvals for managed-care panels and hospital privileges.

Contract Services↗
PubMedDate not supplied

Gastrointestinal endoscopy training in India.

A structured endoscopy training program with clear goals for proper teaching and evaluation serves to alleviate apprehensions in the minds of trainees regarding this crucial area. It also ensures that training is acquired not in isolation but in the setting of ongoing patient care, so that the emphasis is on how the procedure fits into the overall management plan for the patient. By specifying the details of the endoscopy unit set-up, the qualifications of the trainer and the number of procedures to be performed by the trainee, it is hoped that uniformity will be produced in the quality of training imparted, whether it be in a teaching or a non-teaching hospital. The end-product of such training, through the DM/MCh or the DNB stream, is a gastroenterologist who is also a certified endoscopist, capable of performing all standard diagnostic and therapeutic procedures. A further period of focused training for 1 to 2 years is required to achieve the level of competence expected of an advanced therapeutic endoscopist. There is little room for short-term training courses in endoscopy for the basic training of an endoscopist, although such courses are useful as CME activities, for the maintenance and renewal of skills of the trained endoscopist, as well as providing him with exposure to new and evolving therapeutic techniques. Efforts at improving and standardizing the training and practice of GI endoscopy in India are likely to remain exercises in futility without the active and dynamic involvement of all the leading professional societies in the country. The need of the hour is the establishment of technical committees for laying down standards in training and practice of GI endoscopy that should be voluntarily approved by all these societies so that they may then be implemented by the State medical councils and the MCI. A move in this direction from within the profession is far more appropriate and is also likely to find greater acceptance than such moves imposed from above, at the behest of judicial authorities. A system of hospital accreditation committees for large public and private sector hospitals offering endoscopy services, supervised by the accreditation committee of the State medical council, needs to be established. Clinics and nursing homes offering these services also need to be approved by the same committee after meeting standards similar to those laid down for larger hospitals. Mechanisms for audits of performance and outcome of endoscopic procedures as well as periodic participation in CME activities for maintenance of skills and expertise need to be established and linked to periodic renewal of credentials for practising GI endoscopy. Procedures for credentialing for new endoscopic techniques need to be established. The path ahead is long and arduous but we must tread it for it will only become more difficult if we procrastinate.

Clinical Competence↗
PubMed2000

Magnet nursing award is more than a gold star.

Winning hospitals find application data useful, too. If you want to apply for the American Nurses Credentialing Center's Magnet Recognition Program, be forewarned: It is a daunting application that asks for documentation providing you meet 14 different criteria -- from having visible nursing leadership and nurse involvement in planning and decision making to ensuring you have enough staff with rge right credentials and good salaries and benefits.

Awards and Prizes↗
PubMed2003

Respiratory therapists' attitudes toward recredentialing.

Recredentialing, sometimes referred to as recertification, is the process whereby people maintain their professional credentials by retesting or continuing education. The National Board for Respiratory Care has proposed mandatory recredentialing policies for respiratory therapists who receive a professional credential after July 1, 2002. The purpose of this study was to determine respiratory therapists' attitudes toward recredentialing. The author developed a survey instrument that was mailed to a systematic random sample of 1,000 subjects drawn from the active membership of the American Association for Respiratory Care. Data analysis consisted of frequencies, percentages, and measures of central tendency. Group means were compared using the independent groups t-test, with a significance level of p < or = 0.05. Of the surveys, 562 (56.2%) were returned. Of the 15 statements about recredentialing that were rated on a 5-point Likert scale, the respondents were most in agreement with "Proof of continuing education should be sufficient for recredentialing"; "There should be a way to determine whether a respiratory therapist is competent to practice"; and "I don't want to be required to recredential." In response to the multiple-choice question "Who should be in charge of assuring the continuing competency of respiratory therapists, the most frequently selected response was "Employers of respiratory therapists." Most respiratory therapists do not want to be required to recredential. If they are required to recredential, however, they prefer the use of contining education rather than retesting.

Allied Health Personnel↗
PubMed1992

International migration and medical credentialling.

The Single European Act of July 1987, coupled with various other regional and national laws, the purposes of which open borders to the free movement of peoples, goods and services, is soon to be put into operation. Although awaited with much eagerness and expectation, there is also a need for strategic planning in order adequately to address new and possibly ominous legal and medical practice problems. In the United States, a National Practitioner Data Bank, which went into full operation in September 1990 was created to monitor physicians, nurses and other health care providers involved in negligence actions which result in the payment of moneys by settlement or by verdict, and to prevent those whose licences have been suspended, revoked or restricted in any fashion in one state from practising in another based upon reciprocity licensure or board certification criteria. In order to protect patients from abuse by uncredentialled individuals or dangerous clinicians, and further to protect institutions from liability incurred by inadequate credentials checks or through ostensible liability, the creation of a practitioner data bank utilizing modern data gathering, storage and retrieval methods is proposed for the European Community. It should be created under the auspices of the United Nations--possibly through the World Health Organization which already accredits medical education and training programmes--and should be charged with creating uniform standards of professional practice; certifying professionals; and serving as a credentials' clearing house for the health care industry.

Credentialing↗
PubMed2006

Position paper on the development of a middle level provider in nuclear medicine: the nuclear medicine practitioner.

The development of an educational program and credentialing structure to support and recognize an advanced level of the practice of nuclear medicine technology is now underway. This work parallels the efforts in many, if not most, health care disciplines as they seek to achieve the twin goals of developing enhanced career paths and providing the best possible patient care in an environment where science and technology can run roughshod over concepts taught in the classroom a mere decade ago. Education is key to both goals. A master's level degree in nuclear medicine technology, coupled with an advanced practice credential recognizing both the educational achievement and a level of clinical expertise, will give nuclear medicine practitioners the knowledge and the right to practice their profession at a high level of autonomy, leading to more efficient and higher quality health care services. To that end the following position paper was prepared by members of the Advance Practice Task Force of the SNMTS and presented to the SNMTS Executive Council and the SNM Board of Directors. In June 2005, the executive council and the board of directors approved a resolution supporting the establishment of a middle level provider in nuclear medicine known as the nuclear medicine practitioner.

Credentialing↗
PubMed1989

Surgery by non-surgeons: podiatric surgery in Connecticut.

In order to determine the standards for credentialing, privilege delineation, and quality assurance of podiatric surgery in Connecticut, a questionnaire was mailed to all acute care hospitals, with a 100% institutional response. Of 38 hospitals, 25 currently have granted clinical privileges to podiatrists. Full podiatric surgical programs exist in 12 hospitals; multitiered privileges in seven hospitals differentiate podiatrists with and without postgraduate surgical residency training. Credentialing, privilege delineation, and quality assurance generally is conducted through the chief of surgery or chief of orthopedics, with participation of staff podiatrists. Based on the Connecticut experience, recommendations are made regarding establishment of new podiatric surgical programs.

Connecticut↗
PubMed1987

Assessing staff competency.

In the absence of a national credentialing center for nursing and in the interest of ensuring competencies, Forbes Regional Health Center has developed a framework for internal credentialing. This framework, while initiated in a specialty area, has application to all areas of acute care including the medical-surgical areas. Program development within this framework provides a consistent, structured method of documenting selected clinical proficiencies and facilitates the achievement of individual learning needs.

Clinical Competence↗
PubMed1993

Multi-institutional survey of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is being used more frequently in patients undergoing gallbladder removal. Most initial studies have centered on the limited experience of a few select surgeons or institutions and may not accurately reflect the current state of LC. We used written and telephone survey tools to 103 community hospitals in Michigan to identify the utilization of LC, the criteria for training and credentialing, and patient outcome. Of 103 hospitals, 75 (73%) were involved with LC and 56% of these had < 100 beds. We found a large variation in the indications, contraindications, equipment, methods, and credentialing criteria. Major complications, including some not previously reported, were identified and occurred more frequently than previously described. LC is being widely applied and the majority of hospitals have < 100 beds. LC may carry higher risks than previously reported. Collected series and registry data that include community hospital experiences should better delineate the outcome of LC.

Cholecystectomy, Laparoscopic↗
PubMed1992

Analysis of surgical participation in the Advanced Trauma Life Support course. What are the goals and are we meeting them?

Advanced Trauma Life Support (ATLS) course records spanning 4 years were examined and American College of Surgeons members in Washington State surveyed to gain further information on ATLS course participants, skills utilization, and hospital credentialing. Thirty-seven (9.7%) of 382 course participants were trained general surgeons, 56 (14.7%) were surgical residents, and 12 (3.1%) were surgical specialists. One hundred thirty-six (35.6%) of the participants were primary care physicians and 115 (30.1%) were emergency physicians. Surgical residents, primary care physicians, and emergency physicians tended to be overrepresented in ATLS courses in comparison with their general distribution. Fully trained surgeons and surgical specialists were underrepresented. Course participants represented 3.8% of all physicians involved in patient care in the state. Only 6.4% of all active general surgeons in the state were participants, while 39% of active emergency physicians participated. The successful completion rate was 94% (98% for surgeons and 92% for nonsurgical physicians). Thirty-one percent of all American College of Surgeons survey respondents (31% of urban practitioners and 21% of rural practitioners) reported current ATLS qualification. Advanced Trauma Life Support qualification was reported by 31% of respondents as a requirement for taking trauma/emergency department call. Surgeons with a preference not to treat patients with trauma were less likely to have ATLS qualification. More than half of those who reported ATLS qualification had not performed a tracheal intubation, cricothyroidotomy, pericardiocentesis, or emergency department thoracotomy in the previous year. Participation of surgeons in ATLS courses is low, particularly among rural practitioners. Impetus for participation appears related to requirements for hospital staff credentialing and preferences for treating patients with trauma. Performance of procedures taught in the course is rare. Strategies to increase participation need to be formulated and implemented.

Education, Medical, Continuing↗
PubMed2006

Impact of bedside right upper quadrant ultrasonography on radiology imaging.

Many Emergency Departments (ED) use emergency ultrasonography of the right upper quadrant (RUQ) to capture images of the gallbladder in patients with suspected gallstones. It is unclear what impact this practice has on additional imaging performed by radiology. Patients were enrolled 24 h a day by ED residents and attending physicians who have completed an educational program in limited RUQ ultrasound. All ultrasounds were videotaped and later reviewed. According to the American College of Emergency Physicians' credentialing standards, 25 ultrasounds were required before using the results clinically. A total of 352 patients were enrolled by 42 physicians over a 1-year period. Two hundred twelve (60.2%) of the ultrasounds were performed clinically, with the rest performed for teaching purposes. One hundred seventy-nine (50.9%) of the ultrasounds were performed by credentialed physicians. One hundred forty-nine (70%) clinical and 29 (20.7%) teaching ultrasounds had additional imaging. The average time to follow up imaging after discharge from the ED was 8.51 days. Most patients receiving emergency ultrasound of their RUQ had follow-up imaging by radiology.

Abdomen↗
PubMed2004

Radiation risk management during fluoroscopy for interventional pain medicine physicians.

Because of serious radiographic-induced skin injuries that may have been caused by the inappropriate use of fluoroscopy during the performance of radiograph-guided invasive procedures, the US Food and Drug Administration (FDA) issued an advisory in 1994 suggesting that the key to preventing such unfortunate mishaps may be physician education, training, and credentialing in the safe operation of fluoroscopic equipment. The purpose of this article is to familiarize the interventional pain medicine physician with the physics of ionizing radiation and how to limit patient exposure through the optimum setting of tube current and voltage, the use of limited beam-on time, tight collimation, and the elimination of the nonessential use of the magnification mode on a fluoroscopy unit. In addition, the use of personal protection equipment and the knowledge needed to interpret the personal exposure record of each practitioner is discussed. All of this information will assist the interventional pain medicine physician in meeting the recommended FDA training and credentialing requirements.

Fluoroscopy↗
PubMed1991

Medical students who enter general surgery residency programs: a follow-up between 1972 and 1986.

Although a few surgical residents do leave the surgical field, little research has been done into the eventual whereabouts of all surgical residents. We undertook this follow-up to find out what proportion of them enter the surgical field and to identify changing patterns over the past 15 years. We compared 593 medical school graduates on demographics, academic credentials, and surgery program directors' rating of their performance in the first postgraduate year (PGY-1). Sixty percent remained in general surgery, and about 26% moved to another specialty within the surgical field. During the mid-1970s, those who remained within the surgical field had better academic credentials on average than those who switched out of the surgical field. However, more recently, the trend has reversed. There were no differences between the groups on age or sex. These results suggest that some good students are being recruited into surgical programs but are later lost in major career switches. Perhaps these changes are related to residents' preferences for specialties that offer more controllable lifestyles than the surgical field.

Achievement↗
PubMed1989

Radiation therapy technology: manpower survey 1987.

A chronic shortage of radiation therapy technologists exists in the United States. This report presents the data obtained in a 1987 survey of all radiation oncology facilities identified by the Patterns of Care master list. Of the 1,142 questionnaires mailed, 52% were returned. The survey identified 2,328 credentialed (ARRT) and 554 non-credentialed technologists employed in radiation therapy. Of this total of 2,882, 2,141 were identified as staff technologists. A total of 1,186 megavoltage units were identified, giving a ratio of 1.8 technologist/megavoltage unit. Two hundred sixty open funded positions and 230 unfunded positions for radiation therapy technologists were identified. The report compares the results of this 1987 Radiation Therapy Technology Manpower Survey with the results of the three previous surveys conducted in 1975, 1977, and 1981. Whereas this comparison demonstrates that progress has been made, current trends in allied health education are expected to have a negative impact on recruitment into radiation therapy technology. Program directors report that the number and quality of applicants to all allied health education programs is declining, and this trend in radiation therapy technology is substantiated by a drop in the number of students enrolled in programs, from 970 in 1986-87 to 777 in 1987-88. Our discussion addresses the areas of new program development, recruitment, retention, innovative programs, and overseas recruitment.

Allied Health Personnel↗
PubMed2006

Radiation safety with use of I-125 seeds for localization of nonpalpable breast lesions.

RATIONALE AND OBJECTIVES: To describe radiation safety procedures for limiting exposures during localizing placement of iodine-125 (I-125) seeds in nonpalpable breast lesions. Radiation safety tasks included seed receipt, assay, sterilization, transfer, and placement; surgical localization and retrieval; and extraction of seeds by pathologists. Additional regulatory aspects included institutional review board approval, physician credentialing, off-label use, and governmental licensing. MATERIALS AND METHODS: Titanium seeds were assayed to ensure strength (1.85-5.55 MBq). Radiologists credentialed in mammography placed seeds with an 18-gauge needle under ultrasound or mammographic guidance. Surgeons located seeds with a hand-held, solid-state radiation detector. I-125 seeds were extracted from excised tissue and secured by pathologists. RESULTS: After the investigational phase, state permission was obtained for the institution's Radiation Safety Committee to oversee the clinical application of the procedure. In more than 300 procedures, all seeds and targeted lesions were removed successfully; more than 98% of patients had seeds removed within 24 hours. Mean diameter of excised specimens was about 4 cm, for a maximum dose to residual breast tissue of 2 cGy (approximately that of a two-view mammogram). Badge monitoring showed no loss of seeds and no increase in physician or technologist exposure. Radiation safety precautions facilitated safe handling. CONCLUSION: Clinically, the procedure has been accepted as routine, with standardized steps for safe and secure handling of radioactive seeds. Compared with conventional methods, use of I-125 seeds offers an improved method for localizing before surgical excision and has essentially replaced wire localization in our tertiary-care academic medical center.

Breast Diseases↗
PubMed2005

Ultrasound image transmission via camera phones for overreading.

UNLABELLED: Emergency physicians using ultrasound frequently encounter unfamiliar findings during routine ultrasound examination. This is especially common for less experienced practitioners. OBJECTIVE: To compare high-resolution thermal printer ultrasound images and images recorded and transmitted via commercial camera cell phones. METHODS: This was a study comparing randomly selected images of actual ultrasound examinations performed in an academic level I ED with hospital-based emergency ultrasound credentialing. Two hospital credentialed emergency sonologists with extensive experience were asked to review 50 randomly selected images from actual patients as seen on a camera cell phone screen after being captured from a high-resolution thermal printout and sent to a similar phone. Reviewers recorded initial impression of the image and identified structures, measurements, and pathology. After hearing a brief clinical vignette, reviewer rated the images for image quality, detail, resolution, as previously defined, on a 10-point Likert scale. This process was then repeated with the original thermal printouts. Data were analyzed using descriptive statistics, agreement analysis, and the Student t test. RESULTS: Reviewers showed good interrater agreement for pathology and structure detection between phone and thermal printer images. There was no statistically significant difference in image quality, resolution, and detail between phone images and thermal printer images. However, there was statistically significantly increase in confidence in diagnosis for reviewers when using thermal printer images as compared with phone images, P = .003 and P = .02. Several phone images were felt to be suboptimal, and there was moderate agreement on these between reviewers. CONCLUSIONS: Ultrasound pictures recorded by one phone and then sent to another yielded images that showed no statistically significant differences from traditional high-resolution thermal printouts in image quality, detail, and resolution. Measurements were too small to be read on the camera phones, and reviewers had statistically significantly lower confidence in their diagnosis when using the camera phones to review images.

Cell Phone↗
PubMed2006

Patient follow-up after negative lower extremity bedside ultrasound for deep venous thrombosis in the ED.

OBJECTIVES: To evaluate the rate of patient compliance with follow-up ultrasound (US) examinations 5 to 7 days after emergency physician EP performed US exams to rule out lower extremity deep venous thrombosis (DVT) in the ED. METHODS: This was a prospective observational study at a level I ED with a residency program, US training program, and an annual census of 75000. Hospital-based emergency US credentialing is available and derived from American College of Emergency Physicians guidelines. Five US-credentialed emergency physicians participated in the study. All patients who received negative lower extremity DVT US exams were eligible. All higher risk patients were given verbal and written instructions and provided with prescriptions to have a follow-up US examination 5 to 7 days after their examination in the ED. Those classified as "low risk" based on Wells criteria were excluded. After 3 months, patients were contacted via telephone and asked questions regarding their follow-up US examinations, reasons for not following up, continued symptoms, and thromboembolic events. Statistical methods included descriptive statistics. RESULTS: One hundred fifty-nine patients were eligible for enrollment during the 10-month study period. Eighty-five patients (54%) fell into the higher risk category of these; 54 (64%) were contacted successfully. Fifteen (28%) of the patients contacted had obtained a follow-up US exam. Of the 39 who did not follow-up, 29% were told by their physician that a follow-up US was unnecessary, 21% forgot to follow-up, 8% did not follow-up for financial reasons, 16% felt better, 5% could not arrange a study, 21% were unsure. One patient died from sepsis before a follow-up scan. Two patients were diagnosed with DVT, one at 7 days follow-up and the other 9 months later (this particular patient had their 7-day scan cancelled by their primary care physician). CONCLUSION: Patients who were instructed to obtain follow-up lower extremity US examinations to rule out propagation of unseen, distal DVTs did so at a very low rate in our study. One of the largest impediments in our study population was a patients' primary care physician who may not understand the need for a follow-up US examination.

Emergency Service, Hospital↗