Credentialing for critical care in small hospitals.

Objective: To assess credentialing practices for critical care admissions and procedures in smaller hospitals within the United States.

Methods: A questionnaire was sent to credentialing coordinators of 500 randomly selected American Hospital Association hospitals with fewer than 300 beds.

Measurements And Main Results: Most hospitals validate qualifications for intensive care unit (ICU) admitting and procedural privileges through recommendations only. Fewer (16%) require a specified prior number of procedures to have been performed, and 9% require prospective supervision before privileges are granted. Critical care subspecialists are present in 57% of these hospitals and tend to be in the larger facilities with more critical care beds. Criteria for ICU admission and procedure privileges appear to be inclusive, because family medicine, obstetrics-gynecology, orthopedic surgery, and neurology specialists are often credentialed. The presence of a critical care subspecialist is associated with fewer hospitals credentialing family medicine specialists for ICU admission and procedures but not obstetrician-gynecologists, orthopedic surgeons, or neurologists.

Conclusions: This is a brief descriptive report of hospital policies that define which physicians are permitted to care for critically ill/injured patients in small U.S. hospitals. The presence of a critical care specialist appears to influence only slightly the ICU credentialing processes for other selected specialists.