Article Figures & Tables
Figures
- Fig. 1
Simplified process map illustrating instrument flow between the OR and MDRD. MDRD = medical device reprocessing unit; OR = operating room; RN = registered nurse.
- Fig. 2
(A) Current MO tray. (B) Ideal MO tray determined via the mathematical model. (C) Ideal MO tray determined by clinician review. (D) Ideal MO tray as determined by clinician review with additional information from the mathematical model (combined approach). MO = major orthopedic.
Tables
Variable Value Overage costs, $ 0.48–1.02 Reprocessing cost, $ Simple instruments* 0.19 Complex instruments† 0.43 Time to reprocess, s Simple instruments* 38 Complex instruments† 86 MDRD technician hourly wage, $‡ 30.00 Contamination, $ 0.26 Probability of contamination, % 5 Duration of time delay, min 15.35 OR time cost per minute, $ 34.00 Cost to reprocess tray, $§ 50 Depreciation, $ 0.03–0.33 Cost of purchase, $‡ 30–330 Designated no. of uses 1000 Underage costs, $ 1.47–1.71 Peel-packing cost, $ Simple instruments* 0.99 Complex instruments† 1.24 Disposable packaging cost, $‡ 0.80 Picking cost, $ 0.11 Time to pick single item, min 5.5 No. of pick list items, mean 15 Retrieval time cost, $ 0.33 Probability of occurrence, % 11 RN time to retrieve, min 4 RN hourly wage, $‡ 45 MDRD = medical device reprocessing department; OR = operating room; RN = registered nurse.
↵* Nonhinge, single-hinge and nonluminal instruments.
↵† Multiple-hinge, luminal or sharpness-tested instruments.
↵‡ These data were provided by the accounting department.
↵§ Includes substantial fixed overhead costs that are difficult to allocate to a single tray. As such, the value used was based on the literature.7
Instrument Current quantity Ideal quantity; optimization approach Mathematical model alone Clinician review alone Combined Straight Mayo scissors 1 1 1 1 Curved Mayo scissors 1 1 1 1 Metz scissors 1 0 0 0 Needle drivers 3 3 3 3 Bulldog forceps 1 0 1 0 Sponge sticks 4 2 2 2 Lauer forceps 2 1 2 1 Kelly forceps, short 6 2 4 2 Kocher forceps 2 2 2 2 Long 2 2 2 2 Short 4 2 4 2 Curved Crile hemostatic forceps 6 2 4 2 Sharp towel clips 4 2 4 2 Dull Edna towel clips 2 1 2 2 Jackson retractors Small 2 1 2 2 Medium 1 1 1 1 Large 1 1 1 1 Right-angle (Langenbeck) retractors 2 1 2 2 Right-angle retractors, long 2 1 2 2 Israel rake retractors 2 1 2 0 Bone cutter, large 1 0 0 0 Leksell rongeur 1 1 1 1 Double-action rongeur, small 1 0 1 0 Pointer hohman retractors, small 4 3 4 4 Ruler 1 1 1 1 Cobb elevator 3/4” 2 0 1 1 1/2” 1 0 1 0 3/8” 1 0 1 1 Bone curette No. 1 1 0 1 1 No. 2 1 1 0 0 No. 3 1 1 0 0 No. 3 blade handles 3 1 1 1 No. 3 long blade handles 1 1 1 1 Bayonet forceps 1 1 0 1 Bonnie forceps 2 1 2 2 McKenzie forceps Nontoothed 1 2 0 0 Toothed 1 1 1 1 Forceps Short nontoothed 1 1 0 0 Short toothed 2 0 1 0 Long toothed 1 0 1 1 Adson forceps Nontoothed 1 0 0 0 Toothed 2 2 2 2 No. 9 suction tip 1 0 0 0 No. 11 short suction tip 2 1 1 1 Six-prong rake retractors 2 2 2 2 Four-prong rake retractors 2 0 2 0 Howarth elevators 2 2 2 2 Total 88 47 67 51 Measure Current Optimization approach Mathematical model alone Clinician review alone Combined Quantity of instruments on tray 88 47 67 51 Reduction in quantity, % NA 47 24 42 Reprocessing cost per year, $ 150 000 115 560 132 360 118 920 Savings per year, $ NA 34 440 17 640 31 870 NA = not applicable.
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