Point-of-care ultrasound in pediatric anesthesiology: considerations for training and credentialing.

PURPOSE OF REVIEW: To discuss considerations surrounding the use of point-of-care ultrasound (POCUS) in pediatric anesthesiology. RECENT FINDINGS: POCUS is an indispensable tool in various medical specialties, including pediatric anesthesiology. Credentialing for POCUS should be considered to ensure that practitioners are able to acquire images, interpret them correctly, and use ultrasound to guide procedures safely and effectively. In the absence of formal guidelines for anesthesiology, current practice and oversight varies by institution. In this review, we will explore the significance of POCUS in pediatric anesthesiology, discuss credentialing, and compare the specific requirements and challenges currently associated with using POCUS in pediatric anesthesia. SUMMARY: Point-of-care ultrasound is being utilized by the pediatric anesthesiologist and has the potential to improve patient assessment, procedure guidance, and decision-making. Guidelines increase standardization and quality assurance procedures help maintain high-quality data. Credentialing standards for POCUS in pediatric anesthesiology are essential to ensure that practitioners have the necessary skills and knowledge to use this technology effectively and safely. Currently, there are no national pediatric POCUS guidelines to base credentialing processes on for pediatric anesthesia practices. Further work directed at establishing pediatric-specific curriculum goals and competency standards are needed to train current and future pediatric anesthesia providers and increase overall acceptance of POCUS use.

Dispelling Magnet® Myths.

ABSTRACT: Organizations on the journey to Magnet® excellence have questions. In many cases, those questions are based on myth, not fact. In this month's Magnet Perspectives, we break down the most commonly asked questions, dispel the myths, and explore the resources available to help organizations get the answers they need to achieve Magnet® recognition.

Introducing the 2023 Magnet Application Manual®.

In November, the American Nurses Credentialing Center (ANCC) released its revised 2023 Magnet Application Manual®, the 13th manual in the program's 31-year history. This month's "Magnet Perspectives" takes a deep dive into the new edition of the manual, examining the rigorous, multistep review process, the modernized standards, and the coalition of experts that contributed insights to inform the latest edition. Each edition raises the bar to promote the highest levels of nursing excellence, and the 2023 manual is no exception. Learn how this forward-looking edition addresses emerging challenges and changes to reflect what is happening in healthcare today.

Celebrating Magnet® Nursing Excellence: Meet the Recipients of the 2020 National Magnet Nurse of the Year® Awards and ANCC Magnet Prize®.

This month's Magnet® Perspectives column spotlights the recipients of the 2020 American Nurses Credentialing Center (ANCC) Magnet Program® National Magnet Nurse of the Year Awards and the ANCC Magnet Prize®, sponsored by Cerner, who were recognized during the ANCC National Awards virtual event on May 14, 2021.

Credentialing, Certification, and Peer Review Essentials for the Neurosurgeon.

Credentialing and certification are essential processes during hiring to ensure that the physician is competent and possesses the qualifications and skill sets claimed. Peer review ensures the continuing evolution of these skills to meet a standard of care. We have provided an overview and discussion of these processes in the United States. Credentialing is the process by which a physician is determined to be competent and able to practice, used to ensure that medical staff meets specific standards, and to grant operative privileges at an institution. Certification is a standardized affirmation of a physician's competence on a nationwide basis. Although not legally required to practice in the United States, many institutions emphasize certification for full privileges on an ongoing basis at a hospital. In the United States, peer review of adverse events is a mandatory prerequisite for accreditation. The initial lack of standardization led to the development of the Health Care Quality Improvement Act, which protects those involved in the peer review process from litigation, and the National Provider Databank, which was established as a national database to track misconduct. A focus on quality improvement in the peer review process can lead to improved performance and patient outcomes. A thorough understanding of the processes of credentialing, certification, and peer review in the United States will benefit neurosurgeons by allowing them to know what institutions are looking for as well and their rights and responsibilities in any given situation. It could also be useful to compare these policies and practices in the United States to those in other countries.

Evidence Review for the American College of Surgeons Quality Verification Part II: Processes for Reliable Quality Improvement.

After decades of experience supporting surgical quality and safety by the American College of Surgeons, the American College of Surgeons Quality Verification Program was developed to help hospitals improve surgical quality, safety, and reliability. This review is the second of a 3-part review aiming to synthesize the evidence supporting the main principles of the American College of Surgeons Quality Verification Program. Evidence was systematically reviewed for 5 principles: case review, peer review, credentialing and privileging, data for surveillance, and continuous quality improvement using data. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical fashion, extracted data, and summarized results in a narrative fashion. A total of 9,098 studies across the 5 principles were identified. After exclusion criteria, a total of 184 studies in systematic reviews and primary studies were included for assessment. The identified literature supports the importance of standardized processes and systems to identify problems and improve quality of care.

Guidance on qualifications for fertility counselors: a committee opinion.

This guidance document was developed by the Mental Health Professional Group (MHPG) in partnership with the Practice Committee of the American Society for Reproductive Medicine (ASRM) to help determine the qualifications and training of mental health professionals working in reproductive medicine. This document replaces the document titled "ASRM Qualification Guidelines for Infertility," last published in March 2015 and originally developed in 1995.

Why Nursing Research Matters.

Increasingly, nursing research is considered essential to the achievement of high-quality patient care and outcomes. In this month's Magnet® Perspectives column, we examine the origins of nursing research, its role in creating the Magnet Recognition Program®, and why a culture of clinical inquiry matters for nurses. This column explores how Magnet hospitals have built upon the foundation of seminal research to advance contemporary standards that address some of the challenges faced by healthcare organizations around the world. We offer strategies for nursing leaders to develop robust research-oriented programs in their organizations.

Why Some Nurses Obtain Specialty Certification and Others Do Not.

OBJECTIVE: The aim of this study was to determine whether there are modifiable characteristics of nurses and hospitals associated with nurse specialty certification. BACKGROUND: Hospitals, nurses, and patients benefit from nurse specialty certification, but little actionable evidence guides administrators seeking higher hospital certification rates. METHODS: This is a cross-sectional, secondary data analysis of 20 454 nurses in 471 hospitals across 4 states. RESULTS: Rates of certified nurses varied significantly across hospitals. Higher odds of certification were associated with Magnet® recognition and better hospital work environments at the facility level, and with BSN education, unit type (most notably, oncology), older age, more years of experience, and full-time employment at the individual nurse level. CONCLUSION: Two strategies that hold promise for increasing nurse specialty certification are improving hospital work environments and preferentially hiring BSN nurses.

A Framework for Nursing Excellence.

As the American Nurses Credentialing Center (ANCC) marks its 30th anniversary in 2021, the world's largest and most prestigious nurse credentialing organization has unveiled a new Credentialing Framework for Nursing Excellence. In this month's "Magnet Perspectives," the directors of the ANCC's 6 credentialing programs introduce a new conceptual framework, outline the key concepts for exceptional nursing practice, and describe how ANCC's programs interconnect to invoke a powerful model that healthcare organizations can use to develop and sustain nursing excellence.

Are current credentialing requirements for robotic surgery adequate to ensure surgeon proficiency?

BACKGROUND: Robotic surgery has seen unprecedented growth, requiring hospitals to establish or update credentialing policies regarding this technology. Concerns about verification of robotic surgeon proficiency and the adequacy of current credentialing criteria to maintain patient safety have arisen. The aim of this project was to examine existing institutional credentialing requirements for robotic surgery and evaluate their adequacy in ensuring surgeon proficiency. METHODS: Robotic credentialing policies for community and academic surgery programs were acquired and reviewed. Common criteria across institutions related to credentialing and recredentialing were identified and the average, standard deviation, and range of numeric requirements, if defined, was calculated. Criteria for proctors and assistants were also analyzed. RESULTS: Policies from 42 geographically dispersed US hospitals were reviewed. The majority of policies relied on a defined number of proctored cases as a surrogate for proficiency with an average of 3.24 ± 1.69 and a range of 1-10 cases required for initial credentialing. While 34 policies (81%) addressed maintenance of privileges requirements, there was wide variability in the average number of required robotic cases (7.19 ± 3.28 per year) and range (1-15 cases per year). Only 11 policies (26%) addressed the maximum allowable time gap between robotic cases. CONCLUSION: Significant variability in credentialing policies exists in a representative sample of US hospitals. Most policies require completion of a robotic surgery training course and a small number of proctored cases; however, ongoing objective performance assessments and patient outcome monitoring was rarely described. Existing credentialing policies are likely inadequate to ensure surgeon proficiency; therefore, development and wide implementation of robust credentialing guidelines is recommended to optimize patient safety and outcomes.

Habilitación profesional y condiciones socioeconómicas de los profesionales de medicina en Ecuador / Professional license and socioeconomic conditions in medical doctors in Ecuador

INTRODUCCIÓN: En Ecuador, a partir del marco legal en educación superior del año 2010, es necesaria la aprobación de un examen de habilitación para el ejercicio profesional de los graduados de medicina. OBJETIVO: Analizar los resultados de este examen y las condiciones socioeconómicas de los solicitantes durante el año 2017. Sujetos y métodos: El estudio se basa en los resultados del examen de habilitación profesional para el ejercicio profesional de medicina aplicado en Ecuador en 2016 para 4.439 examinados. Se consideran las puntuaciones obtenidas de los solicitantes y si han aprobado o no. Con el examen, se aplicó una encuesta con variables socioeconómicas. RESULTADOS: Se evidencia que los grupos autodefinidos como étnicamente blancos y los estudiantes provenientes de universidades privadas mantienen promedios significativamente más altos que los estudiantes de universidades públicas y cofinanciadas. Se considera también la trayectoria académica familiar como aspecto favorable para el éxito académico y profesional, medido por el nivel educativo del cabeza de familia. Se demuestra que la mayoría de graduados de medicina no son titulados de primera generación que ha accedido a la universidad, lo que podría ya determinar su éxito en la titulación con respecto a sus pares. CONCLUSIÓN: Se refuerza la correlación positiva entre éxito educativo, como condición del éxito profesional, y las condiciones socioeconómicas

INTRODUCTION: In Ecuador, according to legal framework, to pass medical license examination is necessary for professional qualification. AIM: To analyze the relation between the results of the professional qualification exam of Ecuador's medical graduates and the socio economic conditions of the examined graduates. Subjects and methods: This paper is based on the results and scores of the professional qualification exam of Ecuador's medical graduates applied to 4439 examinees in 2016. RESULTS: It demonstrates that the ethnic groups self defined as white and students coming from private universities maintain significantly higher scores than students from public or co financed universities. The variables involved in the measuring instrument are described as well as the findings through descriptive statistics. The family academic trajectory is also considered as a favorable aspect for professional and academic success, measured in the educational level of the head of household. It shows that most medical graduates are not first generation graduates, which could determine their success with respect to their peers. CONCLUSION: This paper reinforces a positive correlation between educational success, as a condition of professional success, and socioeconomic conditions

Facilitating credentialing and engagement of international physician-migrants during the COVID-19 crisis and beyond.

CONTEXT: Physicians who migrate globally face a daunting series of time-consuming, labor- and resource-intensive procedures to prove their clinical competency before being allowed to practice medicine in a new country. ISSUES: In this commentary, we describe licensing barriers faced by physician-migrants based on the authors' experiences, and reflect also on rapidly implemented measures to address COVID-19 pandemic related workforce shortages. We offer recommendations for potential reductions in bureaucratic regulatory barriers that prohibit mobilization of international medical graduate talent. LESSONS LEARNED: Licensing boards and authorities should strive for standardized, competency-based basic professional recognition. Professional medical societies are well-positioned to guide such competency-based recognition as a more organized, international collaborative effort across specialties. The COVID-19 pandemic facilitated cross-state and international licensing in some regions, highlighting a key opportunity: streamlining professional recognition requirements is achievable.

DNP or PhD as a Credential for Nurse Faculty: Choices and Consequences.

With the inception of the Doctor of Nursing Practice (DNP) as the designated practice doctorate in nursing and ultimate acceptance of the DNP as a terminal degree in nursing by professional nursing organizations, questions have arisen about the implications for faculty appointment in the teaching-learning in nursing. Following a brief discussion of the background of the DNP and recent trends in academic nursing programs, a challenge is presented to nurse faculty and administrators to consider carefully the illuminated critical issues and concerns in planning for the future of teaching-learning in nursing.

Clinical competence statement of the Society for Vascular Surgery on training and credentialing for transcarotid artery revascularization.

As the practice of medicine grows in complexity, the process of defining the expertise required for the competent execution of specific procedures has also become complex. The Society for Vascular Surgery therefore constituted a task force to provide informed recommendations on the knowledge, technical skills, resources, and infrastructure required to obtain and to maintain privileges for the safe and effective performance of transcarotid artery revascularization (TCAR). The TCAR procedure is being adopted rapidly, and it is therefore important that informed guidance be available expeditiously. Formal training in the pathophysiology and diagnosis of carotid occlusive disease and all management options is essential. Appropriate diagnostic, imaging, endovascular, surgical, and monitoring infrastructure is required, as are resources to maintain quality control. Credentialing and privileging require a combination of both open surgical and endovascular skills. As such, physicians must have hospital privileges to perform carotid endarterectomy. They should attend an appropriate program for education and simulated training in TCAR. In addition, physicians must have performed ≥25 endovascular procedures as the primary operator using low-profile rapid-exchange platforms plus ≥5 TCAR procedures as the primary operator (pathway 1); or they may have acquired ≥25 endovascular procedures as the primary operator using low-profile rapid-exchange platforms and a supplement of 5 TCAR procedures under proctored guidance if they have not performed sufficient TCAR procedures (pathway 2); or a team of two physicians can collaborate, combining the endovascular and surgical requirements plus at least 5 TCAR procedures under proctored guidance (pathway 3).

Peer-based credentialing for brachytherapy: Application in permanent seed implant.

PURPOSE: The purpose of the study was to establish a quantitative method for implant quality evaluation in permanent seed implant brachytherapy for credentialing. Delivery-based credentialing will promote consistency in brachytherapy seed delivery and improve patient outcomes. METHODS: A workflow for delivery-based credentialing was outlined and applied to permanent breast seed implant brachytherapy. Delivery simulations were performed on implantable anthropomorphic breast phantoms. Two institutions experienced in permanent seed implant brachytherapy demonstrated the peer credentialing process. Each delivery was evaluated for seed placement accuracy as the measure of implant quality, both for implant accuracy and across five simulations to assess implant variation. Initial credentialing criteria are set based on two factors; the mean seed placement accuracy (implant accuracy) and the mean standard deviation (seed variation) with the threshold for each set with the addition of two standard deviations. RESULTS: Across two institutions, seed placement accuracy (±standard deviation) was calculated for all five delivery simulations to yield 6.1 (±2.6) mm. To set credentialing criteria, the implant accuracy (6.1 mm) plus two standard deviations (2.0 mm) and the seed variation (2.6 mm) plus two standard deviations (0.8) mm yield a threshold of 8.1 ± 3.4 mm. It is expected that 95% of experienced institutions would perform the phantom simulation within this threshold. CONCLUSION: Brachytherapy programs should validate delivery accuracy by formal credentialing, which is standard in external beam programs. This quantitative implant evaluation should be combined with current credentialing standards for permanent seed brachytherapy to form a comprehensive validation of institutional brachytherapy program quality.

Informing the Professional Case Manager's Career Path: Five Lessons.

Professional case management's career path offers countless opportunities to pursue, from attainment of the highest levels of licensure and credentialing to education, and that terminal degree. Defining each point of the journey and individual milestones warrants keen attention to a number of areas. All of these decisions and options evolve in response to the industry landscape, as well as professional and personal development. Five key lessons provide case managers clear starting points to consider the most appropriate career path to travel amid a landscape marked by constant change.

Association of Surgeon Case Numbers of Pancreaticoduodenectomies vs Related Procedures With Patient Outcomes to Inform Volume-Based Credentialing.

Importance: Despite growing interest from various surgical societies and patient safety organizations, concerns remain that volume-based credentialing standards are arbitrary and may fail to recognize a surgeon's full scope of practice. Objective: To evaluate whether surgeon experience with related procedures was associated with better outcomes for pancreaticoduodenectomy compared with procedure-specific experience alone. Design, Setting, and Participants: This proof-of-concept cohort study used the all-payer State Inpatient Databases from 6 geographically diverse states to identify all operations for surgeons who performed at least 1 pancreaticoduodenectomy from January 1, 2012, to December 31, 2014. Each surgeon's mean annual volume for pancreaticoduodenectomies and related complex hepatopancreatobiliary (HPB) procedures was calculated. Outcomes for surgeons above and below a threshold of 12 pancreaticoduodenectomies per year were evaluated. Whether related HPB procedure volume was also associated with better outcomes for surgeons not meeting the procedure-specific threshold was also evaluated. Data were analyzed from March 2 through 20, 2019. Main Outcomes and Measures: Thirty-day mortality and complications. Results: The study cohort included 176 043 patients, of whom 92 064 were female (52.3%), with a mean (SD) age of 59 (17) years. Within 270 hospitals, only 54 of 1028 surgeons (5.3%) met the mean pancreaticoduodenectomy volume threshold from 2012 to 2014. In-hospital mortality after pancreaticoduodenectomy was lower for surgeons who performed 12 or more procedures per year (1.8% [95% CI, 1.1%- 2.4%] vs 4.7% [95% CI, 4.0%-5.4%]; odds ratio, 0.32; 95% CI, 0.21-0.50). However, in-hospital mortality varied 7-fold among surgeons who did not meet the threshold (1.2% [95% CI, 0.8%-1.6%] to 8.4% [95% CI, 7.9%-8.9%]). Increasing HPB case volume was associated with better outcomes for pancreaticoduodenectomy in this group. For example, surgeons performing 2 or fewer pancreaticoduodenectomies annually would need to perform an additional 27 related HPB procedures to match the in-hospital mortality rate of surgeons performing 12 or more pancreaticoduodenectomies. Conclusions and Relevance: In this proof-of-concept cohort study, few surgeons met even modest annual volume thresholds for pancreaticoduodenectomy. The findings suggest that inclusion of related procedure volumes may safely expand the cohort of surgeons credentialed to perform certain procedures under volume-based standards.

Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey.

AIM: To develop a validated tool to measure nursing and midwifery documentation burden. BACKGROUND: While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. DESIGN: Survey development, followed by rwo rounds of content validation (April and May 2019). METHODS: Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I-CVI), subscale (S-CVI/Ave by subscale) and overall content validity indexes (S-CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. RESULTS: Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I-CVI threshold of 0.78. No subscale reached a S-CVI/Ave above 0.8 and the overall scale only achieved a S-CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I-CVI ≥0.78, the S-CVI/Ave was above 0.85 for all subscales and the total S-CVI/Ave was 0.94. CONCLUSION: The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. IMPACT: The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care received.