Bariatric Times - August 2008 - (Page 14) 14 Bariatric Center Spotlight TABLE 1. Center of Excellence requirements Bariatric Times • August 2008 1. The hospital displays an institutional commitment at the highest levels of the medical staff and the institution’s administration to excellence in the care of bariatric surgical patients as documented with an ongoing regularly scheduled in-service education program and credentialing guidelines for bariatric surgery. 2. The hospital will perform at least 125 bariatric surgical cases per year. Each applicant surgeon will have performed at least 125 total bariatric cases with at least 50 cases performed in the preceding 12-month period. 3. The hospital maintains a designated physician medical director for bariatric surgery who participates in the relevant decision-making administrative meetings of the institution. 4. The hospital maintains, within 30 minutes of request, a full complement of the various consultative services required for the care of bariatric surgical patients, including the immediate availability of an Advanced Cardiac Life Support (ACLS)-certified physician on site who can perform patient resuscitations. 5. The hospital maintains a full line of equipment and instruments for the care of bariatric surgical patients, including furniture, wheelchairs, operating room tables, beds, radiologic facilities, surgical instruments, and other facilities suitable for morbidly obese patients. 6. The hospital has a bariatric surgeon who spends a significant portion of his or her efforts in the field of bariatric surgery and who has qualified coverage and support for patient care. 7. The hospital utilizes clinical pathways and orders that facilitate the standardization of perioperative care for the relevant procedure. In addition, all bariatric surgical procedures are standardized for each surgeon. 8. The hospital utilizes designated nurse or physician extenders who are dedicated to serving bariatric surgical patients and who are involved in continuing education in the care of bariatric patients. 9. The hospital makes available organized and supervised support groups for all patients who have undergone bariatric surgery at the institution. 10.The hospital provides documentation of a program dedicated to a goal of long-term patient follow-up of at least 75 percent for bariatric procedures at five years with a monitoring and tracking system for outcomes, and agreement to provide annual outcome summaries to the SRC in a manner consistent with Health Insurance Portability and Accountability Act (HIPAA) regulations. tual creation of a multidisciplinary center for obesity and metabolic disease will provide the ideal setting for fruitful interdisciplinary research, including randomized-controlled trials. Furthermore, since Bellevue Hospital is the tertiary referral center for the New York City public hospital system, there are significant opportunities to expand, including adolescent bariatric surgery, post-bariatric plastic surgery, and beyond. gram. This program has the opportunity to make a major medical impact on the underserved morbidly obese of New York City. REFERENCES 1. 2. Livingston E, Ko C. Socioeconomic characteristics of the population eligible for obesity surgery. Surgery. 2004;135:288–296. Hantry H, Gillen D, Lauderdale D. Trends in bariatric surgical procedures. JAMA. 2005; 294:1909–1917. Parikh M, Laker S, Weiner M,, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg. 2006;202:252–261. Fernandez A, Demaria E, Tichansky D, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239:638–703. Behrns K, Smith C, Kelly K, et al. Reoperative bariatric surgery—lessons learned to improve patient selection and results. Ann Surg. 1993; 218:643–653. Lewis M, Phillips M, Slavotinek J, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701. 3. CONCLUSION A laparoscopic bariatric surgery program can be initiated at a public hospital with the appropriate institutional commitment. COE criteria provide an ideal framework to develop a program. Certain safeguards can be instituted during the early phases of the program to help avoid adverse outcomes. Obtaining good clinical outcomes, especially at the outset, is paramount to a successful bariatric pro- 4. 5. 6.
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