American Lithotripsy Society Patient Care Clinical Considerations


Guidelines for Planning a Quality Assurance Program for Your Lithotripsy Unit


To identify possible problems, focus on, evaluate and try to correct known or suspected problems, as well as make improvements in present areas as indicated.


An individual or group. The individual must possess appropriate knowledge in all aspects of lithotripsy. The lithotripsy staff should be included in planning a QA program; this will increase their acceptance and support of the program.


A. Goals: General results or conditions that you expect to achieve. Goals are broad in scope.

B. Objectives: Similar to goals, but are narrower and more specific.


Goal: To provide high quality care.

Objective: Maintain fluro times less than five minutes and quick pics less than ten per treatment.

Goals usually remain the same, while objectives may change.



The following is a list of various QA screens that are being used in lithotripsy units that responded to our questionnaire. We hope that these will help you in planning your own QA plan. It is important for your QA committee to tailor your QA plan to meet your individual needs.

A. Occurrence Screens: List of standards set forth by the Board of Directors of your center. The occurrence screen will pick up non-compliance of these standards. (i.e. limits on kv, number of shocks, bilateral treatments, fluoroscopy times, interrupted treatments due to patient or equipment problems, etc.)

B. Chart Reviews for Completeness: i.e. H & P, labs, signatures, op-reports,etc.

C. Monthly or quarterly REM averages for your treating physicians. Employee radiation badges.

D. Review of Repeat ESWL's and/or Bilateral ESWL's if your center discourages these.

E. Incident Reports - both patient and employee.

F. Anesthesia related incidence or complications.

G. Drup Utilization/Reactions

H. Physician follow-up reports -- for completeness and appropriate follow-up.

I. Infection Control

1. Urine C & S

2. Tub cultures

3. Random cultures of clinical areas

J. Hearing tests for employees.

K. Review of case delays and cancellations.

L. Credentialling of medical staff.

M. Education: Pre- and post-op training.

N. Pacemaker reviews.

0. Patient satisfaction reviews.

P. Review of post lithotripsy procedures and complications



A. Inservices, counseling, letters.

B. Include the standard that was deviated from, the expected change and time frame in which change is expected to occur, if applicable.

C. Respect a person's dignity.

D. Apply peer pressure when appropriate.

E. Maintain strict confidentiality.



A. Involve staff early. Respect their input.

B. Stress positive outcomes, not just the negative.

C. Be straightforward and nonjudgmental.


The QA Guide; A Resource for Hospital's Quality Assurance. JCAHO; 1980.

Donabedian, Avedis. The Definition of Quality and Approaches to Its Assessment. Volume I. Health Administration Press, Ann Arbor, Michigan. 1980.

Donabedian, Avedis. The Criteria & Standards of Quality. Volume II. Health Administration Press, Ann Arbor, Michigan. 1980.

Donabedian, Avedis. Explorations in Quality Assessment & Monitoring. Volume III. Health Administration Press, Ann Arbor, Michigan. 1980.
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American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088