New Privilege List - Family Medicine - Sutter Medical Center

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SUTTER MEDICAL CENTER, SACRAMENTO Department of Family Medicine Delineation of Privileges NAME: Request Core Obstetrical Privileges Appointment Requirements • Diagnosis and management of premature labor and premature rupture of membranes > 32 weeks • tocolysis • steroids • Management of diet-controlled gestational diabetes • Anesthesia – local, paracervical block Request Tier One Obstetrical Privileges Appointment Requirements Proctoring Required Proctoring Required [ ] Mediolateral episiotomy and repair Must also have been granted Core Obstetrical Privileges and have First (2) cases 1 case [ ] Repair of fourth degree perineal laceration completed an accredited Family Medicine OB fellowship program, or the equivalent thereof (which must be approved by MEC), and provide First (2) cases 1 case [ ] Repair of deep vaginal cervix lacerations adequate documentation of all procedures and number performed. First (2) cases 1 case [ ] Low forceps delivery First (2) cases 2 cases. [ ] Complicated vacuum delivery First (2) cases 2 cases [ ] Management of placental abruption and placenta previa First (1) case None [ ] Management of PIH – mild or moderate First (1) case 1case [ ] Induction of labor by mechanical means, i.e. balloon dilation or laminaria First (1) case 1 case [ ] Management and delivery of VBAC (Must have C-Section privileges to perform without consult) – First (2) cases 1 case [ ] C-Section First (2) cases 2 cases [ ] Postpartum tubal ligation First (1) case 1 case [ ] Retained placenta-complicated – manual removal First (1) case 1 case [ ] Retained placenta-complicated – postpartum curettage First (1) case 1 per [ ] Management of hematoma First (1) case None Request Tier Two Obstetrical Privileges Appointment Requirements Proctoring Required [ ] Management of PIH - severe and HELLP syndrome CONSULT REQUIRED Must also have been granted Core Obstetrical First (1) case 1 case [ ] External version Privileges and have completed an accredited Family Medicine OB First (1) case fellowship program, or the equivalent thereof (which must be approved by 1 case [ ] Management of multiple gestation - includes antepartum care; vaginal MEC), and provide adequate documentation of all procedures and number First (2) cases 2 cases delivery; surgical delivery; version and extraction of 2 nd twin. performed. [ ] Management of insulin-dependent diabetes of pregnancy, antepartum and delivery [ ] Management of pregnancies complicated by pre-existing medical conditions, i.e. renal disease, cardiac disease, pulmonary disease, neurologic disease, hematologic disease, etc. First (2) cases 2 cases First (2) cases 2 cases [ ] Uterine packing First (1) case None [ ] Cerclage placement for incompetent cervix First (2) cases 1 case Reappointment Requirements Reappointment Requirements Reappointment Requirements Number Performed Number Performed Number Performed - A INDICATES OUTPATIENT Page 2 of 4
SUTTER MEDICAL CENTER, SACRAMENTO Department of Family Medicine Delineation of Privileges NAME: Request Tier Two Obstetrical Privileges Appointment Requirements Proctoring Required [ ] Premature labor and premature rupture of membranes < 32 weeks gestation First (2) cases 2 cases Request Core Gynecology Privileges Appointment Requirements [ ] • Medical management of ectopic pregnancy • Medical management of gestational trophoblastic disease • Medical management of PID Proctoring Required . Same as for core Family Medicine privileges See admit proctoring requirements Request Special Gynecology Privileges: Appointment Requirements Proctoring Required [ ] Mini-lap tubal ligation Documentation of experience or training in 10 cases. First (2) cases 2 cases [ ] D&E Documentation of experience or training in 10 cases. First (2) cases 2 cases [ ] D&C ‐ A Documentation of experience or training in 10 cases. First (2) cases 1 case [ ] Culdocentesis Documentation of experience or training in 2 cases. First (2) cases 1 case [ ] LEEP conization of cervix Documentation of experience or training in 10 cases. First (2) cases 1 case Request Newborn / General Pediatric Privileges Appointment Requirements [ ] Newborn Nursery Privileges – allows admission and care of the newborn in the Newborn Nursery Proctoring Required Same as for Core FM privileges First (2) cases *1 case [ ] Circumcision Same as for Core FM privileges First (1) case *1 case [ ] General Pediatric Care (non-newborn) Documentation of experience or training within the previous three years in general pediatric – non-newborn care from either residency training or a TJC accredited hospital. Request Other Special Family Medicine Privileges Appointment Requirements First (4) cases *1 case Proctoring Required [ ] Nasal Pack, Anterior & Posterior. Documentation of experience in 4 cases in previous three years NONE 4 cases [ ] Adult Continuing Care in Critical Care Units Completion of a Family Medicine residency program or documentation of at least two months residency training or experience in the care of patients in Critical Care Units in previous three year period; documentation must be in the form of a letter from the Director of the training program or from the Chief of Service of the TJC accredited hospital. NONE 4 cases Reappointment Requirements Reappointment Requirements Board Certification within three years of completion of a residency program or 10 years of practice in a Joint Commission accredited hospital Reappointment Requirements Reappointment Requirements Reappointment Requirements Number Performed Number Performed Number Performed Number Performed Number Performed Note: Includes ability to see and care for the patient in the critical care setting. Exception: This privilege does not include ventilator management, insertion of monitoring lines or elective intubation. Requests for these privileges must be made separately through the Medicine Department. - A INDICATES OUTPATIENT Page 3 of 4
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