Center of Excellence in Kidney Stone Management
The COEKSM program is focused on improving the safety and quality of kidney stone patient care worldwide and lowering the overall costs associated with successful treatment. Data from COEKSM participants will be used to determine which treatment works best for which patient under what circumstances. This information enables clinicians, patients, payors and policymakers to make informed decisions that improve healthcare at the individual level and for the patient population as a whole. The COEKSM program helps position providers of kidney stone management at the forefront of care and demonstrate the improved outcomes and cost savings that result from a quality initiative.
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1: Institutional Commitment to Excellence
The applicant facility demonstrates a commitment to excellence in urology and kidney stone management from the highest levels of its medical staff and administration.
This commitment includes having specialty-specific credentialing and privileging guidelines in urology.
2: Urological Experience
The applicant facility performs at least 200 kidney stone management procedures annually.
Each applicant urologist serves as the primary urologist for at least 125 qualifying kidney stone management procedures annually.
For urologists, procedures performed at any facility may be used toward volume. Urologists must have served as the primary urologist for a procedure to qualify. If the urologist’s role as primary urologist has been properly documented, procedures performed during fellowship or residency may qualify. Cases in which the urologist served as co-urologist or assisting urologist do not qualify.
Each procedure used for volume must be thoroughly documented to enable a medical chart review.
Volume waivers may be approved in some circumstances.
Procedures that do not qualify include:
- Diagnostic procedures and biopsies
- Diagnostic Cystoscopy
- Transrectal Prostate Biopsy
- Urethral Dilation
3: Physician Program Director
The applicant facility must appoint a Physician Program Director (or Co-Directors) for the COEKSM program. The Physician Program Director(s) must:
- Participate in the relevant decision-making administrative meetings of the facility.
- Be accredited, or in the process of becoming accredited as a COEKSM urologist.
- Be primarily responsible for coordinating the multidisciplinary services and systems for kidney stone management.
- Participate in multidisciplinary team meetings.
Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to urology and kidney stone management are addressed in a comprehensive manner.
4: Consultative Services
The applicant facility must have an intensive care unit and a full complement of consultative services required for the routine and intensive care of kidney stone management patients and their potential complications.
- During procedure and until discharge from the post-anesthesia care unit (PACU):
- Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all urology patients and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA must be available on site within 30 minutes if needed.
- Available on site 24/7 (or at all times when patients are present):
- Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
- Available on site within 30 minutes:
- Critical care specialist (if a critical care specialist is not available, a written transfer protocol that details the transfer plan of urology patients to other emergency or critical care facilities can be provided)
- General Surgeon
- Interventional Radiologist
- Vascular Surgeon
- Available on site within 24 hours:
5: Equipment and Instruments
The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for kidney stone management patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.
If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.
6: Urologist Dedication and Qualified Call Coverage
Each applicant urologist spends a significant portion of their efforts in the field of urology and has active, full privileges in urology at the applicant facility.
Each applicant urologist is board-certified or an active candidate for board certification in urology by the highest certifying authority available.
Each applicant urologist must complete at least 12 hours of continuing medical education (CME) focused on kidney stone management every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or two national or international meetings qualify.
The applicant facility has policies in place that require all kidney stone management urologist to have qualified call coverage and each applicant urologist certifies that each covering urologist is capable of identifying and treating kidney stone management complications.
7: Clinical Pathways and Standardized Operating Procedures
The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for urology patient with stone disease related procedures. The following pathways are required:
- Anesthesia, including monitoring and airway management
- Perioperative care, including monitoring, pain management and airway management
- Deep vein thrombosis (DVT) prevention and management
- Instructions for identification, evaluation and management of early warning signs of complications.
- Preoperative patient preparation, evaluation, patient education, consent and plan of action for discharge that includes follow-up and any necessary patient education
- Pain management
- Post-operative patient education (includes Foley catheter or ostomy care and management) and plan of action for discharge that includes follow-up and any necessary patient education
Each applicant urologist performs each procedure in a standardized manner as allowed by variations in operative circumstances.
Each applicant urologist uses a template for operative note dictation that ensures proper collection of data for surgical procedures.
8: Urological Team and Support Staff
The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as an operative team trained to care for kidney stone management patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings and ongoing kidney stone management program compliance.
The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of kidney stone management and the appropriate management of the kidney stone management patient. In-service topics must include:
- Signs and symptoms of common postoperative complications
- Equipment and surgical instruments
- Clinical pathways
9: Patient Education
The facility and each applicant urologist must provide all kidney stone management patients with comprehensive preoperative patient education.
The facility and each applicant urologist must also have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for each patient’s condition.
10: Continuous Quality Assessment
Each applicant urologist must collect prospective outcomes data on all patients who undergo kidney stone management procedures in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.
Facility Application Fee: $3,975 USD
Surgeon Application Fee: $650 USD
- Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
- Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.
Site Inspection Fees
Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD
- The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to the site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
- Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
- Renewal inspections are required every three years to ensure ongoing program compliance.
Facility Annual Fee: $3,975 USD
Surgeon Annual Fee: $650 USD
- Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.
Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.