Chief of staff
Lawrence M. Shuer You have voted by a wide margin to accept the new medical staff bylaws sent to you for review in August. The SHS board ratified the new bylaws in October.

The new bylaws, which replace a version adopted on July 20, 1994, reflect the enormous changes we have faced since then, including the transition to Stanford Health Services. Bylaws are often described as a living document. In fact, our new bylaws will need to be updated again next year in a few places to deal with changes from the creation of UCSF Stanford Health Care.

Here are a few of the more significant changes reflected in the newly approved bylaws as they affect those of us who practice medicine at Stanford.

  • All monitoring requirements were removed so that each service can review its rules and regulations and institute its own appropriate monitoring or proctoring policies to maintain quality-of-care of new practitioners.

  • We have listed those invasive procedures that require a consent and procedure note in the chart specifying when the procedure is indicated. Most bedside procedures other than phlebotomy, intravenous line placement, arterial blood gas draw, nasogastric tube placement of bladder cauterization will require consents.

  • We have deleted a requirement that two licensed physicians must sign each emergency consent form.

  • Perhaps the most comprehensive change is the retooling of the medical staff's committee structure, which before the revision consisted of at least 30 standing committees. Some of these committees clearly are essential and serve the institution well. Other committees seemed somewhat outdated and perhaps redundant.

    With the new bylaws we are down to 11 standing committees of the medical staff, while a few important committees continue as subcommittees of remaining standing committees. We have elected to keep it simple and mandate only those committees that are needed to satisfy regulatory requirements. Limited-time tasks can be carried out by appointed ad hoc committees.

    The 11 committees continued under the new bylaws include care review, operating room, credentials, infection control, pharmacy and therapeutics, medical records, critical care, perinatal care, nominating, ethics, and physician well-being.

    The transfusion committee will continue as a subcommittee under care review. The total parenteral nutrition committee will serve as a subcommittee to the pharmacy and therapeutics committee. The CPR, emergency department and trauma committees will serve as subcommittees under the critical care committee.

    The disaster committee will now report directly to the Quality Improvement Steering Committee of the UCSF Stanford Health Care corporate board, since it really is an operations committee rather than a medical staff committee.

    The home health committee will now also report directly to the Quality Improvement Steering Committee. The perinatal committee will be moved to the Packard Children's Hospital medical staff to recognize the transfer of care of mothers and newborns to the Johnson Center under the Lucile Packard Children's Hospital.

  • The changes in our organizational structure have prompted us to establish and define the role of chief medical officer. The responsibilities of the chief of staff are also enumerated in this new rendition.
What is clear is that we needed to revisit the bylaws, medical staff rules and regulations as well as the rules and regulations of each service to make certain that we are in compliance with state and national regulatory statutes.

But since this is a living document, we must continue to read the bylaws with an open mind. We must remove any items that are not required and perhaps onerous. We want to ensure that we are following through with things we say we are doing in each of these documents. If not, we want to re-examine whether a particular rule or regulation is really necessary.

I invite you to peruse the new bylaws, rules and regulations of the medical staff and those of your particular service. Although it might appear to be dry reading, keep in mind that this document affects how you spend your workday, not to mention that it updates policies that could affect your patients.

Please let us know if you think further changes are required or if you have questions on any of the changes.

Chief of Staff

President of the medical staff

Fact File: SNF


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