JOURNAL OF ENDOUROLOGY
Volume 31, Number 10, October 2017
ª Mary Ann Liebert, Inc.
Pp. 1026–1031
DOI: 10.1089/end.2017.0463
Contexto del Tema: El advenimiento de los ureteroscopios descartables en los últimos años trajo aparejado distintos cuestionamientos. Su principal punto débil es el costo, al compararse con los equipos reusables (1). Los descartables deben adquirirse para cada cirugía, mientras que los reusables conllevan un desembolso inicial alto que luego se amortiza en la medida en que pasan los procedimientos. En el presente artículo se analiza el proceso desde que un ureteroscopio reutilizable termina de ser usado hasta que está disponible para una nueva cirugía usando la metodología TDABC (Time-Driven Activity Based Costing), o Costeo Basado en Actividades. Este método (2) identifica las actividades que son realizadas con los mismos medios para constituir los grupos de recursos, luego estima los recursos consumidos por cada uno y la capacidad normal de cada grupo de recursos en términos de horas de trabajo. Finalmente calcula los costes unitarios de los inductores (el más habitual es el minuto de trabajo) de cada grupo de recursos, dividiendo el coste de los recursos consumidos entre la capacidad normal. Así se puede desmenuzar cada proceso y saber cuánto tarda y cuánto cuesta.
Resumen: Se trata de un estudio prospectivo de movimiento temporal realizado en la Universidad de California, San Francisco, entre Julio de 2016 y Abril de 2017, donde los autores siguieron a los ureteroscopios flexibles reutilizables después de la conclusión de cada procedimiento quirúrgico. Observaron y cronometraron los pasos individuales en el reprocesamiento desde el momento en que cada ureteroscopio salió de la sala de operaciones a la conclusión del proceso de esterilización y la transferencia del ureteroscopio a almacenamiento. También realizaron lo mismo en los casos en que el equipo fue dañado y fue enviado a reparación. De esta manera, crearon mapas de procesos para el reprocesamiento y la reparación detallando los pasos individuales y sus variaciones. Los datos de costos de mano de obra y materiales desechables utilizados se aplicaron para calcular los costos por paso promedio y por minuto. En total, diez ureteroscopios fueron seguidos y se logró establecer que el promedio de tiempo para el reprocesamiento fue de 229.0 ± 74.4 minutos, mientras que enviar un ureteroscopio para su reparación requirió un estimado de 143 minutos por reparación. La mayoría de los pasos demostraron una baja varianza entre las observaciones cronometradas. El secado del ureteroscopio fue el más largo y el paso de mayor varianza con 126.5 ± 55.7 minutos y dependía en gran medida del flujo manual de aire a través del canal de trabajo de ureteroscopio y posicionamiento de ureteroscopio en el gabinete de secado. Los costos totales por reprocesamiento fueron de 96.13 dólares americanos por episodio, incluido el costo de mano de obra y artículos desechables. Los autores concluyen que la utilización de TDABC delinea el espectro completo de costos asociados con el reprocesamiento de ureteroscopios e identifica áreas para la mejora de procesos, siendo en su institución el momento de secar los equipos. Sugieren que de implementarse un entrenamiento en la técnica de secado de ureteroscopios se podría ahorrar hasta 2 horas por evento de reprocesamiento, evitando potencialmente retrasos costosos.
Valoración Personal
Puntos Fuertes
- Análisis detallado de un proceso que los cirujanos muchas veces desatendemos.
- Llama la atención sobre costos asociados de materiales de por si costosos.
- Al analizar cada paso individualmente, permite identificar puntos donde mejorar para optimizar tiempo y dinero.
- De lectura imprescindible cuando se está analizando el costo de un equipo reusable, ya que estos pasos raramente se analizan.
Puntos Débiles:
- Describe las tareas de una institución en particular.
- No extrapolable a otros centros.
- Costo del dólar no siempre similar entre países.
Dr. Horacio Sanguinetti
Head of Endourology Section
Hospital de Clínicas
Bibliografía
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.
99 replies on “Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing”
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