JOURNAL OF ENDOUROLOGY
Volume 31, Number 10, October 2017
ª Mary Ann Liebert, Inc.
Pp. 1026–1031
DOI: 10.1089/end.2017.0463
Background and significance: The advent of disposable ureteroscopes in recent years has brought with it a number of questions. Their main weakness is cost, when compared to reusable equipment (1). Disposable ones must be acquired for each surgery, while reusable ones entail a high initial outlay that is later amortized as the procedures go by. This article discusses the process from the time a reusable ureteroscope is finished being used until it is available for a new surgery using the TDABC (Time-Driven Activity Based Costing) methodology. This method (2) identifies the activities that are performed with the same means to constitute the resource groups, then estimates the resources consumed by each and the normal capacity of each resource group in terms of work hours. Finally it calculates the unit costs of the inducers (the most common is the minute of work) of each resource group, dividing the cost of the resources consumed by the normal capacity. In this way you can break down each process and know how long it takes and how much it costs.
Summary: This is a prospective, temporary movement study conducted at the University of California, San Francisco, between July 2016 and April 2017, where the authors followed reusable flexible ureteroscopes after the completion of each upper urinary tract ureteroscopy surgical procedure. They observed and timed the individual steps in reprocessing from the time each ureteroscope left the operating room to the completion of the sterilization process and the transfer of the ureteroscope to storage. They also performed the same in cases where equipment was damaged and sent for repair. In this way, they created process maps for reprocessing and repair detailing the individual steps and their variations. Data on labor costs and disposable materials used were applied to calculate average step and minute costs. In total, ten ureteroscopes were tracked and it was established that the average time for reprocessing was 229.0 ± 74.4 minutes, while sending a ureteroscope for repair required an estimated 143 minutes per repair. Most of the steps showed a low variance between the timed observations. Ureteroscope drying was the longest and most variable step with 126.5 ± 55.7 minutes and depended largely on manual air flow through the ureteroscope working channel and positioning of the ureteroscope in the drying cabinet. Total costs for reprocessing were $96.13 per episode, including the cost of labor and disposables. The authors conclude that the use of TDABC outlines the full spectrum of costs associated with ureteroscope reprocessing and identifies areas for process improvement, with the time of drying equipment at their institution. They suggest that training in the ureteroscope drying technique could save up to 2 hours per reprocessing event, potentially avoiding costly delays.
Personal Assessment
Strengths
- Detailed analysis of a process that surgeons often neglect.
- It draws attention to associated costs of already expensive materials.
- By analyzing each step individually, it allows us to identify points of improvement to optimize time and costs.
- Essential reading when analyzing the cost of reusable equipment, since these steps are rarely analyzed.
Weaknesses
- It describes the tasks of a particular institution.
- Can not be extrapolated to other centers.
- Costs in dollars are not always similar between different countries.
Dr. Horacio Sanguinetti
Head of Endourology Section
Hospital de Clínicas
Bibliography
1. The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis. Martin CJ, McAdams SB, Abdul-Muhsin H, Lim VM, Nunez-Nateras R, Tyson MD, Humphreys MR. 3 pt1, 2017, J Urol, Vol. 197, pp. 730-735.
2. Time-Driven Activity-Based Costing. Kaplan RS, Anderson S. 11, 2004, Harvard Business, Vol. 82, pp. 131-138.
152 replies on “Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing”
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