Evaluate existing privileging practices
In order to consider a change to core privileges, you should first examine the privilege delineation system currently in place at your organization. Most likely you will find many examples to bolster your case for a conversion to a criteria-based core privileging system. Areas that you want to evaluate include the following:
- Consider the existing privilege list(s). Are they up-to-date, or are they 30 years old? Are any procedures on the lists obsolete or no longer performed at the organization? If the lists are not current, now is the time to start culling privileges for procedures not currently performed at the facility. If your forms are out-of-date laundry lists, the forms themselves provide ample examples of the complexity, burden, and difficulty in maintaining the multitude of privilege lists.
- Is your privilege delineation system outlined in the bylaws or policies and procedures? There must be some form of continuity to the system.
- Is your privilege delineation system criteria-based? A criteria-based program prevents physicians from applying for privileges they are not competent to perform, which, in turn, prevents denial of privileges. For example, if you require postgraduate training in general surgery to request the core and a physician has not had the required postgraduate training, then that physician does not meet the requirements for those privileges. Therefore, an application for those privileges is never acted upon, and no outright denial (a reportable occurrence and potential trigger of a fair hearing) happens.