Isaacson Dylan, Ahmad Tessnim, Metzler Ian, Tzou David T, Taguchi Kazumi, Usawachintachit Manint, Zetumer Samuel, Sherer Benjamin, Stoller Marshall, Chi Thomas
1 School of Medicine, University of California , San Francisco, San Francisco, California.
2 Department of Urology, University of California , San Francisco, San Francisco, California.
J Endourol. 2017 Oct;31(10):1026-1031. doi: 10.1089/end.2017.0463. Epub 2017 Sep 20.
Careful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevent the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of ureteroscopes sent out for repair can contribute to expensive operating room (OR) delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing.
Direct observation and timing were performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures. Estimated times needed for each step by which damaged ureteroscopes identified during reprocessing are sent for repair were characterized through interviews with purchasing analyst staff. Process maps were created for reprocessing and repair detailing individual step times and their variances. Cost data for labor and disposables used were applied to calculate per minute and average step costs.
Ten ureteroscopes were followed through reprocessing. Process mapping for ureteroscope reprocessing averaged 229.0 ± 74.4 minutes, whereas sending a ureteroscope for repair required an estimated 143 minutes per repair. Most steps demonstrated low variance between timed observations. Ureteroscope drying was the longest and highest variance step at 126.5 ± 55.7 minutes and was highly dependent on manual air flushing through the ureteroscope working channel and ureteroscope positioning in the drying cabinet. Total costs for reprocessing totaled $96.13 per episode, including the cost of labor and disposable items.
Utilizing TDABC delineates the full spectrum of costs associated with ureteroscope reprocessing and identifies areas for process improvement to drive value-based care. At our institution, ureteroscope drying was one clearly identified target area. Implementing training in ureteroscope drying technique could save up to 2 hours per reprocessing event, potentially preventing expensive OR delays.
在输尿管肾镜检查病例中，对可重复使用的软性输尿管镜进行仔细的去污和消毒，可防止传染性病原体传播给患者和技术人员。然而，再处理效率低下以及送去维修的输尿管镜无法使用，可能会导致昂贵的手术室（OR）延误。应用时间驱动作业成本法（TDABC）来描述再处理过程中涉及的时间和成本。
对可重复使用的软性输尿管镜在手术后再处理的所有步骤进行直接观察和计时。通过与采购分析人员面谈，确定了再处理过程中发现的损坏输尿管镜送去维修所需的每个步骤的估计时间。创建了再处理和维修的流程图，详细说明了各个步骤的时间及其差异。应用人工和消耗品的成本数据来计算每分钟成本和平均步骤成本。
跟踪了10台输尿管镜的再处理过程。输尿管镜再处理的流程映射平均为229.0±74.4分钟，而每次送输尿管镜维修估计需要143分钟。大多数步骤在计时观察之间显示出较小的差异。输尿管镜干燥是最长且差异最大的步骤，为126.5±55.7分钟，并且高度依赖于通过输尿管镜工作通道的人工空气冲洗以及输尿管镜在干燥柜中的定位。每次再处理的总成本总计为96.13美元，包括人工成本和一次性用品成本。
利用TDABC可以描绘出与输尿管镜再处理相关的全部成本范围，并确定流程改进的领域，以推动基于价值的医疗。在我们机构，输尿管镜干燥是一个明确确定的目标领域。实施输尿管镜干燥技术培训，每次再处理事件最多可节省2小时，有可能防止昂贵的手术室延误。
