That I have several items of importance to most of you is indicative of key changes in our environment, ranging from last year's merger of clinical operations with UCSF, to legislation and accreditation rule changes intended to keep pace with our changing political and economic world around us.

So, here are a few thoughts:

* Temporary privileges.There was a time when this was almost a retrospective issue, but those days - given matters of liability, billing and documentation - are long gone. In order to grant temporary privileges, our credentialing staff must have copies of every temporary physician's license, DEA licensure, proof of malpractice insurance and CV to be signed off by the appropriate service chief. We also need the name and a brief medical history of every patient the physician plans to treat. By law, we are required to query the National Practitioners Data Bank to verify credentials, etc., and as you can imagine, such a reply cannot be instantaneous. Therefore, the credentialling office needs four to five days to process temporary physician requests. Keep in mind that the requirements are mandated, and we must document for the joint commission (JCAHO) and other agencies that we have followed the appropriate steps. On the other hand, I think there is merit to a thoughtful privileging process. I think all of us can understand the value of ensuring that those whom we allow to practice alongside us are everything we believe and expect them to be.

Also, if someone is joining your group, service or department, let the credentialing office know and provide the newcomer's CV as soon as possible. The credentialing office staff will do everything possible to complete the credentialing and privileging process by the time your colleague arrives. Bear in mind that regular privileges - including provisional staff membership - take several months to complete, because we are required to conduct a comprehensive records check, including collection of medical school transcripts and licensing information from every state in which the applicant has ever practiced. For information, call the credentialing office, 723-7857.

* The Gann Act. Any patient who might need a transfusion on a nonemergent basis must be informed of his or her rights about possible options, including autologous blood. Physicians or their designates (including nurses or clerical personnel) must give the patient the state-mandated booklet explaining rights and options. (No, it doesn't have to be the state's booklet; it just has to say everything covered in the booklet.) Nursing units are being reminded to stock these booklets, and administration is exploring the possibility of giving all patients a copy of the booklet at the time of admission. Though this could be disconcerting to a patient coming here for a procedure with a low likelihood of a transfusion, I think we'd rather err on that side than on the side of a patient suddenly faced with the need for a transfusion and struggling to understand the options and risks.

* Informed consent. The guidelines that we use to help patients understand the risks, benefits, and alternatives of procedures are being revised to state that "when possible, the physician will use language, on the consent form, understood by the patient." To make this possible, we must be more diligent than ever about calling on an interpreter when a patient whose primary language is not English needs to be "informed" of a procedure or asked to complete and sign a required consent form. We have forms available in Spanish and we are exploring the possibility of expanding our language menu. Keep in mind that the burden of proving that the patient understood what was explained will include documentation by the physician that the patient's primary language was used to explain the procedure.

* New peer review guidelines. The care review committee, which I chair, has approved a new quality review worksheet that replaces an earlier care review form that rated incidents on a four-point scale - with two levels representing care outside the normal standard. We found in departmental committee meetings that much of the discussion using the old forms centered on what numerical rating to give an incident, rather than on what occurred, what could be improved and, most important, what systems or procedures could constructively address issues that went wrong. We found also that by revising the forms, we could better structure the questions to help physicians and other caregivers decide which cases should be forwarded to the care review committee for a hospitalwide review. The new forms are also a response to our finding that departments evaluated issues of quality in divergent ways. To bring a more constructive tone and greater consistency to these evaluations, our quality managers are presenting the new forms at care review conferences and making themselves available to meet with small groups of physicians and staff. We hope that this will refocus the care review process to make it constructive, rather than punitive.

* Bylaws. Yes, we've just revised our bylaws. Many of you remember voting on our latest revision several months ago. The bylaws are a living document, and we will continue to look at them regularly to identify areas that might need revision to keep pace with the many changes that are occurring within the institution, as well as resulting from outside forces. An ad hoc bylaws committee has been convened to continue this review.

President of the Medical Staff

Chief Medical Officer, UCSF Stanford Health Care

Fact File: Sleep
  Q&A

People

NEWS
News Summary

UCSF Stanford expands Brown & Toland to include Stanford doctors

Commencement '98

Credentialing Staff Honored at Banquet

Pharmacy Reopens

Jacobs / Reitz

Physician Heads Care Quality Function at UCSF Stanford

HOME