Cardioversion Privileges

[salaj]

I am the solo PA working for the EP service of a moderate sized hospital based cardiology group in Maine. I have been trying to get privileges in performing elective cardioversion on patient's I am evaluating in clinic. My privilege request has been repeatedly tabled due to a lack of precedent in our area (the credetanialing committee would like an example of a PA or NP somewhere with such privileges). Anyone out there who is working in either cardiology or EP that is performing non-emergent cardioversion? If so - can you let me know where you work.

[UGoLong]

I live in a large city and don't know of anyone with those privileges. You would likely have to have privileges for conscious sedation and doing a TEE, as well as the cardioversion. 

 

Not to say that it can't be done, but I've not come across it. You might try the ACC's group for PAs and NPs and see if they know of anyone.

 

Good luck.

[REMPAC]

I have privileges for conscious sedation, and TEE.  Send me a messge offline if you want to know more.

[CardioPA]

I interviewed for a position at Massachusetts General Hospital a couple of years ago where some of the PAs and NPs did cardioversions.  You might check with their EP department.

[etacalpha]

I am confused with this topic. I am a paramedic and preform cardioversion a few times a year. I understand that the majority of the time it's due to protocols and unstable patients. There has never been an issue about choosing electric over drug therapy as long as patient was moderately sedated prior to cardioversion. I do not understand why there would be an issue for for a Physician Assistant who has more knowledge than a paramedic to preform this procedure inside a hospital when I can do it going down the road with no assistance if something goes wrong. Is there something I just do not understand or more to this procedure than taught in ACLS? 

[SoCalPA]

I think EMEDPA has those privs. Maybe he will post.

 

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[EMEDPA]

there is a difference between having emergent privileges and elective privileges.

[Houstonian]

I am confused with this topic. I am a paramedic and preform cardioversion a few times a year. I understand that the majority of the time it's due to protocols and unstable patients. There has never been an issue about choosing electric over drug therapy as long as patient was moderately sedated prior to cardioversion. I do not understand why there would be an issue for for a Physician Assistant who has more knowledge than a paramedic to preform this procedure inside a hospital when I can do it going down the road with no assistance if something goes wrong. Is there something I just do not understand or more to this procedure than taught in ACLS?

 

Paramedic must be able to perform life-saving emergent therapy, including intubation, cardioversion if required...because no one else is on the scene, and this is performed by protocol. Once patient arrives to ED or hospital, paramedic responsibilities cease. Then hospital designates which providers can perform which responsibilities. Other than emergent situation (defibrillation for ACLS), cardioversion is typically performed by cardiologist or physician. Most hospitals have not credentialed PA's or NP's to do this, although some might. There actually is more to know than just how to shock the patient ( a monkey could do that!). Must know is cardioversion is appropriate or not, administration of conscious sedation, management of anticoagulation before and after procedure. Transesophageal echocardiogram is also often required, and this requires specialized skill set in performing and interpretation. Training in performing and interpreting TEE is definitely not provided in PA school, so most hospitals want proof of fellowship training in this and demonstrated competency in records of procedures performed, etc. Hope this helps to answer question.