Credentialing and Privileging of Clinicians

The primary responsibility of providing appropriate clinical care to a patient rests with the doctor under whose care the patient is receiving treatment. Thus, the outcome of care in a patient, to a very large extent, depends upon the expertise of the treating doctor. A doctor who is inadequately qualified or competent to handle a patient’s case can in-fact do more harm than good. Hence, it is extremely important that the patients are being treated by the right doctor. When doctors are employed or contracted by hospitals, it is the responsibility of the hospital to ensure that their patients are being treated by the right doctor. Hence it is a must for a hospital committed to provide high quality clinical care to have a robust policy on credentialing and privileging of clinicians. 

Uniform Care Policy for Hospitals

Healthcare organizations treats patients with different background (such as religion, economic class, literacy level, race, language etc.) and in different settings (such as general ward, sharing room, single room and deluxe room). They are expected to not to discriminate between their patients and provide them a uniform medical care per their clinical requirement. To ensure this, hospitals must have a policy that specifies what constitutes uniform care and what practices must be followed to ensure that patients are not discriminated on the basis of their background or category of their accommodation. The essential part of the policy is provision of uniform medical care and does not applies to those services and facilities that are non-clinical in nature.

Patient identification Policy and Procedure

One of the most common causes of medical errors in healthcare is the incorrect identification of patients. The error can lead to potentially serious consequences such as surgery of a wrong patient or transfusion of wrong blood into a patient. It is vital that hospitals must put into place an effective policy and procedure for identifying a patient. Below are the internationally recommended practices for accurately identifying a patient.

Restraining a patient

Hospitals commonly use restraint on patients as a mean to prevent injury or harm to self or others. However, if appropriate care is not taken, restraint itself can cause serious injuries and even deaths to patients. Also, as restraint is an act of restricting an individual’s freedom of movement, generally against his/her will, it can be considered as an infringement of patient’s rights, if used without strong and valid reason. It is for these reasons, use of restraint on a patient must be guided by a comprehensive policy, that takes care of safety and rights of patients.

The guidelines given below are intended to serve as a reference for hospitals for making their policy on restraint of patients.

End-of-life care: policies and procedures for hospitals

Patients who are in their end stage of life have unique problems. While they suffer with disease symptoms and treatment side-effects they also face psycho-social, cultural and spiritual issues related to the process of dying. The family of a dying patient suffers with grief and needs help in coping with it. The emotions and sensitivities surrounding a dying patient is significantly higher than other patients. These distinctiveness of a dying patient makes it important for hospitals to understand their unique needs and develop policies and practices to fulfill their rights. Following paragraphs explains some of these needs and how can hospitals help in addressing them.

Nutritional Screening and Nutritional Assessment in Hospitalized patients

Nutritional screening is the first and rather quick evaluation of a patient’s nutritional condition. The end result of nutritional screening is to find if there is any indication for detailed nutritional assessment and possibly a nutritional intervention. Nutritional assessment is an in-depth evaluation of a patient to identify and quantify specific nutritional needs and intervention. The end result of nutritional assessment is a nutritional plan which is based upon specific nutritional problems of the patient.

Nutritional screening should be done for all patients admitted in hospital and nutritional assessment is done only for indicated patients. This is mandated by many regulatory and accreditation authority across the world including NABH of India. While nutritional screening can be done either by a dietician, a doctor or a nurse, detailed nutritional assessment should be done by a qualified dietician.

There are research evidences that nutritional needs, if not addressed, adversely affect the treatment outcome of patient. Hence, a hospital that is committed to provide good quality healthcare, must include nutritional screening and nutritional assessment as an integral part of their clinical practices. This is also an accreditation requirement. 

Following important points must be ensured for nutritional screening and assessment.