Scope of privileges at the ambulatory site

When a hospital has established which ambulatory sites require practitioners to be privileged, its medical staff needs to evaluate the scope of services provided at the site by physicians and advanced practice professionals, such as nurse practitioners and physician assistants. Thereafter, the medical staff delineates site-specific privileges and commensurate criteria.

For example, the scope of privileges defined for an office-based family practitioner would differ from a family practitioner in an urgent care center or birthing center. The office-based physician could potentially be caring for patients of all ages and may or may not do minor procedures. The physician at the urgent care center would generally be treating minor injuries and illnesses and not be providing preventive medicine, such as immunizations, Pap smears, or smoking cessation counseling. The family practitioner practicing at the birthing center would only need privileges related to obstetrics and newborn care.

Examples of ambulatory privileges versus acute care privileges are:

• The family practitioner may not treat any pediatric or newborn patients in the hospital but may see this patient population in the office setting.
• The family practitioner or internal medicine specialist may not do Pap smears, proctology examinations, vasectomies, or joint injections in the acute care setting but may elect to perform these procedures in the ambulatory site.
• The physician providing care in the urgent care center may be allowed to suture lacerations but may not meet the minimum criteria to do so in the hospital’s emergency department.

Once the care provided in the various hospital-owned ambulatory sites has been defined, the medical staff has several options for designing the privilege delineation form. The options might include:

• If the privileges and eligibility criteria already described in the hospital privilege form match the privileges for the ambulatory site, the organization could simply add the additional site(s) of care to the existing privilege form.
• If the privileges and eligibility criteria are very similar and essentially cover the same practitioners, the organization may simply add language such as “office-based practice” and identify the privileges/procedures that would apply in that setting only.
• Create an ambulatory site privilege form specific to the clinical practice at that site. This would need to be done for any practitioner who did not practice in the acute care setting.

Source: The Medical Staff's Guide to Overcoming Competence Assessment Challenges