Secrets Clutched in a Dead Hand: Rethinking Posthumous Psychotherapist-Patient Privilege in the Light of Reason and Experience with Other Evidentiary Privileges.

Attorney-client privilege was held by the Supreme Court to extend beyond death in 1996, albeit only ratifying centuries of accepted practice in the lower courts and England before them. But with the lawyer's client dead, the natural outcome of such a rule is that privilege--the legal enforcement of secrecy--will persist forever, for only the dead client could ever have waived and thus end it. Perpetuity is not traditionally favored by the law for good reason, and yet a long and broad line of precedent endorses its application to privilege. The recent emergence of a novel species of privilege for psychotherapy, however, affords an opportunity to take a fresh look at the long-tolerated enigma of eternity and the imprudence of thoughtlessly importing it to the newest addition to the family of privileges. Frankly, humanity has always deserved better than legalisms arrogating to the inscrutability of the infinite.

Hospital-Based Credentialing and Privileging: Overview and Implications for the Clinical Nurse Specialist.

PURPOSE/OBJECTIVES: The purpose of this article is to provide an overview of hospital-based credentialing and privileging processes for clinical nurse specialists (CNSs), describe barriers to success, and share lessons learned from CNSs who have successfully navigated the credentialing and privileging process. DESCRIPTION OF PROJECT: This article shares knowledge, experiences, and lessons learned from an initiative to achieve hospital credentialing and privileging for CNSs at 1 academic medical center. OUTCOME: Policies and procedures for credentialing and privileging CNSs are now consistent with other advanced practice providers.

Outcomes of a contemporary credentialing and privileging program in a dental school.

The current credentialing and privileging (C&P) climate has evolved due to a risk reduction/management awareness of increased institutional legal liability. This recognition affects dental colleges and has caused the implementation of C&P processes. Contemporary best practices for methods, processes, and structure are reported here. Data reported from the process show how and what clinicians' red flags were discovered during the process. Conclusions include the following: C&P is a significant process to introduce in terms of institutional resources and commitment. This process includes increased clinician and administrative burden that needs to have a governor. Attention to experiences of other institutions can reduce but not eliminate challenges from the clinician and some administrators. A primary data-based verification process administered by a credentialing specialist can make the process valid and workable.

Quality and Safety in Healthcare, Part LXXII: Credentialing and Privileging.

ABSTRACT: Healthcare credentialing is the methodology used by an organization to obtain and validate a practitioner's credentials, typically to participate in patient care. Privileging is the process by which the designated individuals in the healthcare organization evaluate the credentials, as well as the performance of the individual to determine that the provider is worthy to have certain privileges in the institution to contribute to the care of patients. The healthcare institution must have appropriate processes to ensure that providers continue to give excellent care in order to maintain privileges. There must also be procedures in place for remediation and revocation of privileges when necessary, as well as an appeals procedure. In addition, there should be provisions for privileging of temporary workers and for privileging in emergency situations.

Frontline perspective on credentialing and privileging of ambulatory care pharmacists.

OBJECTIVES: To present the current state of, and frontline advice on, the implementation of successful credentialing and privileging processes for practicing pharmacists in the United States. METHODS: The American Society of Health-System Pharmacists (ASHP) Section Advisory Group on Compensation and Practice Sustainability surveyed ambulatory care pharmacists via ASHP Connect about the status, structure and oversight of their ambulatory care clinical practice sites with credentialed and privileged (C&P) pharmacists. KEY FINDINGS: Over 80% of survey respondents identified themselves as a C&P pharmacist, and over 90% indicated it is 'Important' or 'Very Important' for pharmacists to be C&P. Qualitative survey responses indicated the most important considerations for establishing or expanding a credentialing and privileging process for ambulatory care pharmacists were 'don't re-create the wheel', 'establish a physician champion and/or obtain leadership buy-in', 'be persistent and patient', 'develop a guidance document' and 'work within existing processes'. CONCLUSIONS: Starting a credentialing and privileging process is critical in preparation for, or response to, provider status recognition of pharmacists in the United States. When used with existing guidance documents on credentialing and privileging, 'front line' advice from practicing pharmacists can help promote expanded roles for pharmacists within healthcare systems.

Enteral and Parenteral Order Writing Survey-A Collaborative Evaluation Between the Academy of Nutrition and Dietetics' Dietitians in Nutrition Support Dietetics Practice Group and the American Society for Parenteral and Enteral Nutrition (ASPEN) Dietetics Practice Section.

INTRODUCTION: In 2014 and 2017, the Centers for Medicare and Medicaid Services authorized nutrition-related ordering privileges for registered dietitian nutritionists (RDNs) in hospital and long-term care settings, respectively. Despite this practice advancement, information describing current parenteral nutrition (PN) and enteral nutrition (EN) ordering practices is lacking. Dietitians in Nutrition Support, a dietetic practice group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society of Parenteral and Enteral Nutrition (ASPEN) utilized a survey to describe PN and EN ordering practices among RDNs in the United States. METHODS: A cross-sectional study design was utilized to describe RDN PN and EN ordering privileges. Respondents were asked to describe PN and EN ordering privileges, primary practice setting, primary patient population served, nutrition specialty certification, highest degree earned, career length, and if applicable, the nature of prior denials for ordering privileges or reasons for not applying for ordering privileges. RESULTS: Seven hundred two RDNs completed the survey (12% response rate), with 664 RDNs providing complete data. The majority of respondents (n = 558) cared for adult/geriatric patients. Among this subset, 47% had no PN ordering privileges; 14% could order and sign PN; 28% could order PN with provider cosignature; 10% could order partial PN with provider cosignature. Nineteen percent of RDNs had no EN ordering privileges; 37% could order and sign EN; 44% could order EN with provider cosignature. RDNs with ordering privileges were more likely to have a nutrition specialty certification and work in an academic or community hospital setting. CONCLUSION: PN and EN ordering privileges are varied because of institution and state requirements. Future research describing the outcomes associated with RDN ordering privileges is needed. This paper has been approved by the Academy's Research, International, and Scientific Affairs team and Council on Research and the ASPEN Board of Directors. This article has been co-published with permission in the Journal of the Academy of Nutrition and Dietetics. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.

NP and PA Privileging in Acute Care Settings: Do Scope of Practice Laws Matter?

As hospitals' interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation. We also find a strong correlation between NP and PA privileging in all four clinical areas. These results suggest the need for additional research to understand the institutional-level variables and human dynamics at the level of medical staffing committees that may explain the dramatic variation in privileging policies and, ultimately, the effects of different privileging levels on costs and quality.

A systematic review of the psychology literature addressing hospital practice.

Hospitals, with their unique practice constraints and opportunities, are one of the most important arenas wherein the field of clinical psychology has developed throughout its history. However, there have been few efforts to comprehensively examine the literature on this topic. This is a literature worth examining, not only out of historical interest but also in the effort to provide direction for the field. Accordingly, systematic, scoping review methods were used to address the question: What does the psychology literature tell us about the nature and evolution of psychology practice in hospitals? The review identified 115 papers on this topic dating from 1916-2017, primarily in the form of practice commentaries and case studies. Analysis of the papers revealed 2 broad themes. One involved the nature of hospital practice, which concentrated on the major domains of assessment, psychotherapy and research activities along with issues related to training. The second involved structural and policy-related considerations such as cost-effectiveness and reimbursement models, leadership, the structure of practice, relationship to physicians, and hospital privileges. Implications of the review include the need for better data on the hospital practices of psychologists and continued work on role definition and the unique value of psychology. Other implications include direction for training models, practice models such as stepped care and a compromise between program and department-based management, privileges, and mental health reform. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Hospital and Surgical Privileges for Doctors of Podiatric Medicine.

The Board of Directors of the American Board of Podiatric Medicine approved the following position statement regarding hospital and surgical privileges for doctors of podiatric medicine on February 27, 2019. This statement is based on federal law, Centers for Medicare and Medicaid Services Conditions of Participation and Standards of the Joint Commission, and takes into account the current education, training, and experience of podiatrists to recommend best practices for hospital credentialing and privileging.

Expanded Practice in Midwifery: Designing, Implementing, and Maintaining Programs.

Advances in health care science and delivery, coupled with patient need for access to care, have driven expanded practice in midwifery for decades. The process for development and implementation of expanded practices for midwives and midwifery practices is described. Important components include assessment of need, identifying stakeholders and supporters, development of a program proposal, obtaining privileges, developing training programs, and conducting ongoing quality management and program evaluation. Examples of expanded practice in midwifery are presented.

Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis.

BACKGROUND: Significant progress has been made in implementing direct access. As more therapists transition into direct access roles, it seems prudent to consider how additional resources common to other first-contact providers might impact patient care. OBJECTIVES: Direct referral for diagnostic imaging by physical therapists is relatively rare in the civilian setting and little has been published on the subject. The primary objective of this study was to examine the appropriateness of diagnostic imaging studies referred by civilian physical therapists at an academic medical center. Secondary objectives were to track reimbursement data and overall use rates. DESIGN: This was a single-center, retrospective practice analysis of 10 physical therapists over a period of nearly 5 years. METHODS: The electronic medical record was reviewed for each patient who had an imaging referral placed by a physical therapist. Relevant clinical exam findings and patient history were provided to a radiologist who then applied the American College of Radiology Appropriateness Criteria to determine appropriateness. Reimbursement data and therapist use rates were also evaluated. RESULTS: Of the 108 total imaging studies, 91% were considered appropriate. Overall, use rates per direct access evaluation were 9% for plain film x-rays and 4% for advanced imaging. Reimbursement was 100%. LIMITATIONS: This study was limited to 10 physical therapists at 1 practice location. Appropriateness was evaluated by 1 radiologist. The educational background of referring therapists was not evaluated. CONCLUSIONS: Physical therapists demonstrated appropriate use of diagnostic imaging in the vast majority of cases (91%). They were judicious in their use of imaging, and there were no issues with reimbursement. These findings could be useful for physical therapists interested in acquiring diagnostic imaging referral privileges.

Effect of Registered Dietitian Nutritionist Order-Writing Privileges on Enteral Nutrition Administration in Selected Intensive Care Units.

BACKGROUND: Adequate nutrition is linked to improved patient outcomes during critical illness. Nutrition care is further enhanced by registered dietitian nutritionist (RDN) order-writing privileges, which improve the implementation of nutrition interventions. The purpose of this performance improvement project was to evaluate the effect of RDN order-writing privileges on enteral nutrition (EN) order compliance and nutrition delivery in selected intensive care units (ICUs) at a university-affiliated teaching hospital. METHODS: Patients admitted to selected ICUs from January 23, 2018, to January 25, 2018, were screened for eligibility. Demographic and nutrition data were collected retrospectively from the electronic health record. Percent of energy and protein needs met were calculated. Data were compared with historical internal controls identified prior to RDN order-writing privileges. RESULTS: Fifty adult patients (150 EN days) were included in data analysis, with 93 patients (279 EN days) included in historical data. Compared with historical data, cumulative EN order compliance increased by 17% and tube feed infusion rate compliance by 15% post-RDN order-writing privileges. Mean (± SD) protein needs delivered significantly increased from 72.1 ± 28.6% to 89.1 ± 24.8% after RDN order-writing implementation (P < 0.001). CONCLUSIONS: RDN order-writing privileges improved EN order compliance and significantly improved protein delivery in selected ICUs. Future studies are recommended to confirm these results and determine if other variables besides protein delivery are statistically significant with a larger sample size.