Dylan Isaacson, Tessnim Ahmad, Ian Metzler, David T. Tzou, Kazumi Taguchi, Manint Usawachintachit, Samuel Zetumer, Benjamin Sherer, Marshall Stoller, Thomas Chi

Purpose Careful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevents the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of scopes sent out for repair can contribute to expensive operating room delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing. Materials and Methods Direct observation and timing was performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures. Estimated times needed for each step by which damaged scopes 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. Results Ten ureteroscopes were followed through reprocessing. Process mapping for ureteroscope reprocessing averaged 229.0 ± 74.4 minutes while sending a scope for repair required an estimated 143 minutes per repair. Most steps demonstrated low variance between timed observations. Scope drying was the longest and highest-variance step at 126.5 ± 55.7 min and was highly dependent on manual air flushing through the scope working channel and scope positioning in the drying cabinet. Total costs for reprocessing totaled $96.13 per episode, including the cost of labor and disposable items. Conclusions 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, scope drying was one clearly identified target area. Implementing training in scope drying technique could save up to two hours per reprocessing event, potentially preventing expensive operating room delays.