Logging/credentialing for inpatient procedures (for hospitalist work/open ICU)

[MedicineZ0Z]

I'm at a residency in the South and I'm really interested in doing a combination of full scope outpatient and hospitalist work with an open-ICU model where the hospitalist is responsible for as much as possible (codes, placing lines, intubating, paras/thoras etc.). And the region I'm looking at living post-residency has plenty of those opportunities (and they're all very open to FM trained docs).

My main question is, what is the credentialing process like for procedures within the hospital? Do you need to keep a very accurate log of every little thing you do in residency, and then they go over that? Is there anything additional I should be gathering?
Thanks

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[redpanda]

Yes, you should be keeping procedure logs of everything through residency and these are often submitted in support of the credentialing process. In terms of the procedures that you may be credentialed for, you may want to get an idea of how much procedure volume you might expect, because there may be a minimum number of X procedures over Y years to maintain credentialing. In addition, you may want to consider the estimated procedural volume in terms of whether you'll actually be doing enough of any given procedure to maintain competency and be able to appropriately deal with emergent complications, especially some of the higher risk stuff, like advanced airway management, the thoracentesis that turns into a need for a real chest tube, etc.

 

[MedicineZ0Z]

Yes, you should be keeping procedure logs of everything through residency and these are often submitted in support of the credentialing process. In terms of the procedures that you may be credentialed for, you may want to get an idea of how much procedure volume you might expect, because there may be a minimum number of X procedures over Y years to maintain credentialing. In addition, you may want to consider the estimated procedural volume in terms of whether you'll actually be doing enough of any given procedure to maintain competency and be able to appropriately deal with emergent complications, especially some of the higher risk stuff, like advanced airway management, the thoracentesis that turns into a need for a real chest tube, etc.

I know my target location will have more than enough sufficient volume to maintain (and really improve) competency.
I guess I'm just not sure how many of Xyz they expect to credential you. But my sense is that the absolute number needed per procedure generally is on the lower end?

 

[redpanda]

Often the number required by the institution for certain procedures is on the rather low end for credentialing, but that does not assure competency for any given procedure. For example, one institution where I have been requires what appears to be an extraordinarily low number of endotracheal intubations to credential its moonlighters (think, like 5) and those moonlighters do have something not far off from that number. For the typical respiratory failure ICU patient in this unit, I am quite wary of having someone with so little airway mangement experience being primary on those (both from the execution and knowledge of when to call for backup). Obviously, only you know your own experience and training here, but be careful with taking on these high risk procedures when the discrepancy between credentialing numbers and numbers that would be considered adequate for people who are generally considered experienced and routine operators of a procedure are very different.

 

[MedicineZ0Z]

Often the number required by the institution for certain procedures is on the rather low end for credentialing, but that does not assure competency for any given procedure. For example, one institution where I have been requires what appears to be an extraordinarily low number of endotracheal intubations to credential its moonlighters (think, like 5) and those moonlighters do have something not far off from that number. For the typical respiratory failure ICU patient in this unit, I am quite wary of having someone with so little airway mangement experience being primary on those (both from the execution and knowledge of when to call for backup). Obviously, only you know your own experience and training here, but be careful with taking on these high risk procedures when the discrepancy between credentialing numbers and numbers that would be considered adequate for people who are generally considered experienced and routine operators of a procedure are very different.

No I totally get that. I would look at competency numbers for airways at being significantly higher than that and and maybe a dozen or so for things like lines and single digits for some other things.
I also think there are some excellent courses out there that can help you improve.