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PinnacleHealth Hospital
REQUEST FOR CARDIOVASCULAR SERVICES (CARDIOLOGY)
Basic Education and Minimum Formal Training:
QUALIFICATIONS FOR CARDIOVASCULAR SERVICES (CARDIOLOGY): Current certification in internal medicine and active participation in the
examination process leading to subspecialty certification in cardiovascular disease by the American Board of Internal Medicine or the American
Osteopathic Board of Internal
Medicine,
Or
Successful completion of an accredited fellowship training program in cardiovascular disease during which at least three (3) years were devoted
to cardiovascular medicine and documentation of cardiovascular procedures during the past 24 months to include:

300 cardiac catheterizations

50 stress tests

10 temporary pacemaker insertions

10 Swan-Ganz

75 holter monitors
OBSERVATION/PROCTORING REQUIREMENTS: As specified in the medical staff bylaws, credentialing policies and procedures, or rules and
regulations.
Request
Cardiology Core Privileges
Admit, evaluate, diagnose, and provide treatment or consultative services to patients presenting
with cardiovascular disease. Privileges include advanced cardiac life support (ACLS),
cardioversion, insertion and management of central venous and pulmonary artery catheters, use
of thrombolytic agents, pericardiocentesis, Holter scanning, pacemaker re-programming,
temporary transvenous pacemaker placement, and intra-aortic balloon pump placement.
Administration of moderate sedation in accordance with hospital policy
Initial Request Criteria: Reading, reviewing materials on current best practice and successful
completion of post test.
Reappointment Criteria: Demonstration and documentation of successful completion of 12 cases
in prior 24 months. If 12 cases are not performed in prior 24 months, you will be required to take
the post test.
Approve
Disapprove
Fluoroscopy in accordance with hospital policy
Must provide documentation of completion of a safety training update every 2 years, current
demonstrated competence and an adequate volume of current experience with acceptable
results.
Request
Osteopathic Manipulative Therapy
Core for Doctors of Osteopathic Medicine; evidence of training and experience for Doctors of
Medicine.
Approve
Disapprove
Request
Cardiac Cath Lab Core Privileges
Cardiac catheterization and angiography privileges, including the following procedures: Right
heart catheterization, temporary pacemaker insertion, left heart catheterization, angiographic
injections including the right atrium, right ventricle, left atrium, left ventricle, aorta, pulmonary
artery, coronary arteries, bypass grafts, pericardiocentesis.
*In addition to general qualifications, requires documented training and ability in cardiac
catheterization and cardiac arteriography.
Approve
Disapprove
Request
Intracoronary (Angioplasty) Interventions
Percutaneous balloon angioplasty
Intracoronary stent
Thrombolytic therapy-IC
Directional coronary atherectomy
Rotational coronary atherectomy
Laser
Completion of an approved 8 hour minimum CME course which includes training in laser
principles and safety, basic laser physics, laser tissue interaction, discussions of the clinical
specialty field and hands-on experience with lasers. A letter outlining the content and successful
completion of a course must be submitted, or documentation of successful completion of an
Approve
Disapprove
PinnacleHealth Hospital
REQUEST FOR CARDIOVASCULAR SERVICES (CARDIOLOGY)
approved residency in a specialty or subspecialty which included training in laser principles and
safety, basic laser physics, laser tissue interaction, discussions of the clinical specialty field and a
minimum of 6 hours observation and hands-on experience with lasers.
Clinical Cardiac Electrophysiologic Studies
Intracardiac electrophysiologic studies of arrhythmia evaluation and treament, pacemaker
programming, defibrillator programming, tilt table testing, permanent pacemaker insertion and
transvenous AICD.
Laser Extraction of Implanted Electrophysiology Lead Devices
Required Training/Experience:

Completion of an accredited Electrophysiology fellowship program.

Letter from the EP program director certifying completion of the training for laser lead
extraction as well as certifying the number of cases completed.
Reappointment Requirement:

Evidence of performance of procedure in the last reappointment schedule with
satisfactory outcomes as determined by department chair.
Request
Cardiology Special Procedures
Robotic Catheter System
Required Training/Experience:

Satisfactorily completing mandatory product training provided by Hansen Medical,
And

The first two cases performed with the robotic catheter system at a PinnacleHealth
Hospital facility must be precepted by a physician credentialed to perform the robotic
catheter system at PinnacleHealth Hospitals and observed by a physician designated by
the chairperson of the department of the preceptee as qualified to perform this
function. Said preceptor and preceptee must have privileges for use of the robotic
catheter system at PinnacleHealth Hospitals.
Reappointment Requirement:
Six procedures in the previous 2 year reappointment cycle with satisfactory outcomes as
determined by the QA review process.
Echocardiography interpretation including stress echocardiography
Transesophageal echocardiography
Required Training:

Completion of an ACGME/AOA approved residency/fellowship in cardiology

Certified attendance at a basic course in echocardiography and transesophagel
echocardiography.
Required Experience:

Have basic experience in evaluation of ventricular function, valvular function, and
Doppler evaluations. (This can be accomplished co-operative with Cardiologists).

Precepted performance of 25 TEEs including esophageal intubation techniques
Reappointment Requirement:
Satisfactory review and certification by the departmental chair is required.
Nuclear cardiology imaging and interpretation
Endovascular procedures
includes peripheral angioplasty/stents, renal artery, distal abdominal aorta, subclavian arteries,
thrombolysis, atherectomy, rotoblator and popiteal approach
Intracardiac Echocardiography
Required Training:

Completion of an ACGME/AOA approved residency/fellowship in cardiology.

Completion of an intracardiac echocardiography training course or have received
specific training in intracardiac echo during residency/fellowship.

Must possess Cardiac Cath Lab I Core privileges.
Required Experience:
Documentation of the satisfactory performance of a minimum of 5 intracardiac echos during the
approved residency/fellowship training program.
Reappointment Requirement:
For the continued privilege within a two-year reappointment cycle, the minimum requirement is
Approve
Disapprove
PinnacleHealth Hospital
REQUEST FOR CARDIOVASCULAR SERVICES (CARDIOLOGY)
satisfactory study performance and interpretation as determined by the departmental chair and
departmental quality assurance program.
Aortic Endoluminal Graft Placement (AEGP)
Required Training:

Completion of an ACGME/AOA approved residency/fellowship in cardiology.

Privileges to perform endovascular procedures in PinnacleHealth Hospitals.
Required Experience:
Physicians who received training in AEGP during residency/fellowship:

Performance of ten (10) AEGP cases as a fellow certified by Chief of Service and

Performance of five (5) additional AEGP cases at PinnacleHealth Hospitals/System
under the supervision of a physician credentialed to perform AEGP at PinnacleHealth
who will act as primary operator on these cases, and by an authorized representative of
the AEG manufacturer; and

Completion of a 2-day didactic course on AEGP.
Physicians who did not receive training in AEGP during
residency/fellowship:

Performance of ten (10) AEGP cases at PinnacleHealth Hospitals under the direction of
a physician credentialed to perform AEGP at PinnacleHealth who will act as primary
operator on these cases; and an authorized representative of the AEG manufacturer
and

Completion of a 2-day didactic course on AEGP.
Reappointment Requirement:
Documentation of continued clinical competence in the performance of AEGP as determined by
the Chairman of the Department who will review all available volume and outcome data for each
operator.
Cardiac Magnetic Resonance Imaging-MRI Imaging of the Pericardium and its Contents
Required Training:

Completion of a cardiology, radiology, or nuclear medicine ACGME accredited training
program and board eligible.

Basic knowledge, clinical training and experience in at least one other cardiac imaging
modality.
Required Experience:
For a physician to practice CMR imaging and provide official interpretation, the following are
required:

At least 3 months full-time training in CMR

At least 50 hours of CMR related coursework

Supervised interpretation of a least 150 cases. For at least 50 of these cases, the
trainee should perform the analysis and make the initial interpretation.
Reappointment Requirement:

CME’s in CMR for at least 20 hours for every 2 years

Primary interpretation of at least 50 cases per year.
Percutaneous Aortic Valvuloplasty (PAV)
Required Training:

Completion of an Internal Medicine residency or equivalent.

Completion of an accredited Cardiology fellowship or equivalent.
Required Experience:

Possession of Interventional Cardiac Catheterization privileges at PinnacleHealth
Hospitals and

Performance of at least 3 percutaneous valvuloplasty procedures, independently or
under supervision, during training or during practice following training.
Reappointment Requirement:
Performance of at least two (2) PVs during the prior appointment period with outcomes judged
satisfactory by standing quality assurance procedures
Percutaneous Closure of Atrial Septal Defects Utilizing an Occluder Device
Required Training:

Completion of an ACGME/AOA approved residency/fellowship in cardiology.

Must possess Cardiac Cath Lab Core I privileges.

Documentation of specific training in the use of septal occlude devices either during
PinnacleHealth Hospital
REQUEST FOR CARDIOVASCULAR SERVICES (CARDIOLOGY)
residency/fellowship or in subsequent training course.
Required Experience:

Active cardiac catheterization experience performing a minimum of 75 cardiac
catheterizations per year.

Documentation of the satisfactory performance of a minimum of 5 device deployments
under supervision during the approved residency/fellowship or training program.
Reappointment Requirement:
Within a two-year reappointment cycle:

Performance of 10 device deployments with satisfactory outcome as determined by
departmental chair and quality assurance program.

Performance of a minimum of 150 cardiac catheterization
Insertion of Atrial Appendage Closure Device
Required Training:
Completion of an accredited interventional cardiology fellowship program.
Required Experience

Actively practicing peripheral interventionist

Satisfactory completion of the manufacturer’s education and instructional program.
Reappointment Requirement:
Satisfactory performance of 10 cases as primary or secondary operator per the two-year period
immediately preceding reappointment.
Interpretation of Vascular Laboratory Studies
Required Training:
Completion of an ACGME/AOA approved residency/fellowship in cardiology, vascular surgery,
cardiovascular surgery or general surgery.
Required Experience:
See the Intersocietal Commission for the Accreditation of Vascular Laboratories standards
attached.
Reappointment Requirement:
Minimum of 15 hours of relevant CME activity per three (3) years.
Cardiac Computed Tomography
Required Training:

Board certification in Cardiology or

Completion of an ACGME accredited Cardiology Fellowship and

Twenty (20) hours of course work devoted to CCT and

Training (prior to formally interpreting any studies) in use of Image Processing Software
currently in use at PinnacleHealth Hospital.
Required Experience:
Evidence of involvement in the performance and interpretation of at least 150 CCT studies
including contrast and non-contrast studies.
Reappointment Requirement
During a two year reappointment period:

Performance of 100 CCT examinations

15 hours of Category 1 CME in CCT
Please list any Core Privileges you do not wish to exercise:
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
I have requested and will perform only those privileges for which I am qualified by education, training, current experience and demonstrated
performance. I further acknowledge that my professional liability insurance coverage includes all of the privileges which I am seeking and I will,
at all times, maintain coverage for all privileges performed. I further acknowledge that professional liability insurance coverage limits must be in
those amounts required by Pennsylvania law or as otherwise required by the Medical Staff.
PinnacleHealth Hospital
REQUEST FOR CARDIOVASCULAR SERVICES (CARDIOLOGY)
I understand that in exercising clinical privileges, I am subject to the bylaws, policies, procedures, rules and regulations of the Medical Staff.
____________________________________________
Practitioner’s Signature
___________________
Date
Based upon the review of training, education, knowledge, current competency and health status, I recommend the indicated privileges.
____________________________________________
Department Chair
___________________
Date
Date recommended by Credentialing Committee: ______________________________
Date recommended by Medical Executive Committee: _________________________
Date approved by Board of Directors: _______________________________________