Guidelines for hospital privileges in vascular surgery: An update by an ad hoc committee of the American Association for Vascular Surgery and the Society for Vascular Surgery

When vascular surgery emerged as a separate specialty from its general surgery parent, hospitals were in need of guidelines for granting privileges to individuals wishing to practice vascular surgery. In 1989, a report of an ad hoc committee of the Joint Council of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery (North American Chapter) was published. The Guidelines for Hospital Privileges in Vascular Surgery was widely accepted and became the primary source document for hospital credentials committees. In the ensuing 12 years, vascular surgery has continued to expand as a specialty. Therefore, there is a clear need to update the original guidelines for hospital privileges. The new ad hoc committee of the American Association for Vascular Surgery and the Society for Vascular Surgery was charged with this responsibility. Since the publication of the 1989 document, 4 developments have occurred that have made this update necessary. The first is the publication of multiple studies that document the variability of practice and outcomes of common vascular procedures. Most of these studies have established a clear relationship between good outcomes and high volume of procedures performed for individual surgeons and, conversely, alarmingly high morbidity and mortality rates for surgeons who have performed a low volume of procedures. Some studies document significantly better outcomes in trained vascular surgeons who are board-certified in vascular surgery. The second development has been the incorporation of catheter-based endovascular therapies into the practice of vascular surgery. The Accreditation Council for Graduate Medical Education (ACGME) has designated endovascular therapies as an important component of vascular surgery training and has said that contemporary graduates from vascular residencies should be trained in endovascular intervention. The third development was the formation of the Vascular Surgery Board of the American Board of Surgery (VSB-ABS). The American Board of Surgery (ABS) has delegated responsibility to the VSB-ABS for all board/examination-related activities pertaining to vascular surgery. The final development has been the competence initiative of the American Board of Medical Specialties (ABMS). This organization has charged all of their member boards with developing mechanisms to link board certification and competence. Until now, board certification and recertification in most medical specialties were primarily dependent on passing examinations that tested cognitive knowledge and judgment ability. The charge to all boards by the ABMS is to expand areas of assessment to include professionalism, evidence of ongoing learning, ethical conduct, interpersonal skills, and evidence of attempts at practice improvement on the basis of outcomes. Although proper training and certification are a means of defining a surgeon’s qualifications, they do not assure competence in a particular specialty. The ultimate determination of who should and should not practice vascular surgery in a given hospital is the responsibility of the individual hospital through its credentialing mechanisms. This report will define optimal criteria for credentialing, although they may require modification by individual hospitals to meet local community needs and standards. The ultimate goal in preparing this document is to assist hospitals and practicing physicians in improving the quality of care and treatment outcomes for patients with vascular disease. From the Division of Vascular Surgery, UCLA Center for the Health Sciences. Competition of interest: nil. Reprint requests: Wesley S. Moore, MD, Professor of Surgery, Division of Vascular Surgery, UCLA Center for the Health Sciences, 10833 LeConte Ave, Room 72-156, Los Angeles, CA 90095-6904 (e-mail: wmoore@mednet.ucla.edu). J Vasc Surg 2002;36:1276-82. Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery. 0741-5214/2002/$35.00 0 24/9/129651 doi:10.1067/mva.2002.129651