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ICE Provisional Qualifications

Achieving provisional status is the first major milestone that must be reached to earn the ICE designation.

Bariatric surgeons and their facilities are encouraged to apply to the ICE program as soon as they commit to establishing a culture of excellence within their bariatric program. Once this decision is made, applying for and achieving provisional approval is often a simple step.

Surgeons and facilities are able to attain provisional status as soon they meet the program’s provisional qualifications, which are easily achieved and align with each of the 10 requirements for ICE designation.

Provisional approval, which typically occurs within one week of receiving the center’s provisional applications, does not require a site inspection. Provisional status is necessary before applying for designation.

Importantly, surgeons and hospitals may not publicly announce or market provisional status. Centers must achieve designation before promoting their involvement in the ICE program.

ICE Provisional Qualifications

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1. Institutional Commitment to Excellence

Hospitals and surgeons should be committed to developing an excellent bariatric program. Hospitals should define – or be in the process of defining – bariatric surgery credentialing and privileging guidelines that are specific to the bariatric program and separate from general surgery guidelines.

2. Surgical Experience and Volumes

Hospitals may have any number of bariatric surgical cases, but surgeons must have served as the primary surgeon for at least 25 bariatric surgeries in their lifetime. If the surgeon’s role as primary surgeon is properly documented, these surgeries may have been performed during a fellowship or residency. Only primary bariatric surgical procedures formally recognized by the ICE program count toward the hospital and surgeon volume requirements.

3. Designated Medical Director

Hospitals should have a designated physician medical director for bariatric surgery. This individual should currently or in the future participate in interdisciplinary team meetings to ensure that bariatric-related decisions are addressed in a comprehensive manner. The director may be self-appointed or officially appointed through the hospital’s standard administrative process. The director may be acting, interim or permanent.

4. Responsive Critical Care Support

Hospitals should have immediate on-site availability of a physician who is advanced cardiac life support (ACLS)-qualified or has equivalent advanced life support training and certification. This ensures that a qualified provider is able to perform patient resuscitations at any time, including cases where anesthesia is not being given and/or to perform airway management in the event of a sudden respiratory arrest.

5. Appropriate Equipment and Instruments

Hospitals and surgeons should have, or be in the process of acquiring, the equipment and instruments appropriate for the care of bariatric surgery patients.

6. Surgeon Dedication and Qualified Call Coverage

Surgeons should be certified or eligible for certification by a certifying authority approved by the IBSRC.

7. Clinical Pathways and Standardized Operating Procedures

Hospitals and surgeons should have developed at least one of the 15 clinical pathways listed in Requirement 7 of the ICE program:

  • Anesthesia, including monitoring and airway management
  • Perioperative care, including monitoring and airway management
  • Deep vein thrombosis (DVT) management
  • Management of warning signs of complications such as tachycardia, fever and hemorrhage
  • Indications
  • Contraindications
  • Initial patient instruction
  • Patient evaluation
  • Laboratory studies
  • Imaging studies
  • Patient education/consent
  • Admission workup and evaluation
  • Preoperative and postoperative nutrition regimen
  • Wound care management
  • Pain management

8. Bariatric Nurses, Physician Extenders and Program Coordinator

Hospitals should have designated surgical and nonsurgical nurses as well as physician extenders who serve bariatric surgical patients. Bariatric surgery programs also need to have identified a designated bariatric program coordinator who supervises program development.

9. Patient Support Groups

Bariatric programs should offer or commit to offer organized and supervised support groups for bariatric surgery patients. Support groups may be organized by the surgical practice, the hospital or both as long as the party responsible for administering each support group is clearly identified. Patients should be informed of their support group options.

10. Long-Term Patient Follow-Up, Including BOLD

Surgeons should agree to provide surgical information on all patients to SRC through the Bariatric Outcomes Longitudinal DatabaseTM (BOLDTM) in a manner consistent with applicable patient privacy and confidentiality regulations. They should identify their BOLD Administrator and agree to be BOLD-activated within 30 days of being approved for provisional status.

Learn more about BOLD activation and approvals that enable ICE participants to enter patient information into BOLD.