Training in Laser Bronchoscopy and Proposals for Credentialling: Proposals to Improve Training and the Ongoing Practice of Laser Bronchoscopy (Part 2)
The Inter-Society Commission for Heart Disease Resources was far more explicit in addressing the issue of caseload criteria, stating that, “A new cardiac surgical program should reasonably expect to attain an annual rate of 75 pump-assisted procedures within one year, and 200 such procedures within three years of initiation. Within a defined geographic area, the establishment of additional cardiac surgical units should be discouraged until hospitals already providing satisfactory services are operating at these acceptable levels. . . . New cardiac surgical services should not be established if they will interfere with the level of efficiency of existing units. This commission went on to discuss the issues of caseloads in greater detail; the development and maintenance of clinical proficiency; the need for initial response time for emergencies; efficient and economical use of personnel and facilities; unproductive competition; and the qualifications of professional staff.
The reader should not think that such guidelines are intended for cardiac surgery alone; the InterSociety Commission also published annual caseload guidelines for cardiac catheterizations by hospitals (300 per year) and physicians (150 per year), and even for implantable cardiac pacemakers (50 implantations per year per hospital, and 25 new and five or more replacement pacemakers per year per physician). In my opinion, the latter caseload recommendations are appropriate for laser bronchoscopy (50 per year per hospital, and 25 per year per physician). Others might argue that only surgeons should do laser bronchoscopy, or that such procedures should be done only in a large academic or referral center. I would resist such arguments, but I do feel that any physician or hospital group which wants to begin laser bronchoscopy must be held to some caseload criteria and review of outcome/complications after an initial probationary period so as to assure quality care for patients. buy ortho tri-cyclen