Board 312 - Research Abstract Privileging with Simulation-Based Assessment for Hospital-Based Procedures

Abstract

Introduction/Background Privileging is the process by which an institution grants permission to a provider to perform patient care activities. When a hospital grants privileges, it “explicitly endows a [provider] with the right to perform that procedure within its physical and administrative confines”.2 The use of simulation-based assessment (SBA) allows providers to practice and be assessed on a predetermined set of procedures in a controlled and standardized setting until acceptable performance is reached.23 As privileging programs shift toward competency-based assessment, simulation is being utilized to both gain and maintain privileges.25 However, the scope of existing privileging programs that utilize SBA and exactly how SBA is incorporated remains unclear. The objective of this study was to survey simulation centers regarding existing and planned privileging programs that incorporate SBA. Methods Ninety two simulation centers were included in the survey. For feasibility, only simulation centers that were accredited by either the American College of Surgeons (ACS) or from the Society for Simulation in Healthcare (SSiH) were included. The survey took approximately 20-30 minutes to complete and was addressed to directors of simulation centers. Survey data was collected from March through April 2013. Results Twenty seven simulation centers responded (29%). The majority of centers were associated with public hospitals (62%); 33% of centers were associated with private hospitals. All were associated with teaching hospitals. A majority of centers had approximately 5,000-10,000 square feet. Regarding the number of full time employees (FTE’s), this ranged widely from 1 – 52. Nineteen procedures were included in the survey; these were determined based on a review of the literature.33 The procedures that were most often selected as having existing SBA privileging programs included central venous catheterization, sedation, laparoscopic surgery and robotic surgery. The procedures that were most often selected for SBA privileging programs in development included GI endoscopy and bronchoscopy procedures. All of the nineteen procedures surveyed had at least one center with either a current or future SBA program in development. Additional procedures centers reported SBA privileging programs included vein graft harvesting and airway management. Reasons for beginning such programs included desire to develop standards, risk management, patient safety, response or cost reduction related to adverse events, targeting of procedures that occur less frequently and cost reduction related to training. The majority of centers required all providers who performed the given procedure to participate in the program (57%). Centers collaborated with human resources (17%), risk management/legal (33%), quality improvement/quality assurance (42%), medical staff office (58%), continuing medical education (42%), and patient safety (25%). A majority of centers utilized their programs for initial privileging of new providers (57%). Top barriers included institutional political support, provider resistance to participate, litigation from providers (i.e. provider sues hospital if denied privileges), and simulation center staffing and equipment. Methods to develop content for SBA privileging programs included internal expert opinion (69%), literature review (54%), and multi-department (46%) or interprofessional (38%) committees. One center reported that they worked with a credentialing committee; no other Methods of choosing criteria were reported. Methods of delivering the SBA privileging program included testing performance on simulation models (77%) and the use of performance-based checklists (62%). None of the centers reported a method for assessing procedural competency. Conclusion It is clear from the Results that simulation centers are developing SBA privileging programs. However, the process is fragmented as centers are developing programs as single institutions. Further research, publication and guidance is needed so that simulation centers can learn from each other regarding best practices when delivering SBA privileging programs.