Part 2: Unrecognized Costs in Computer Assisted Surgery – Equipment Malfunction and Repair.
This is the first in a series highlighting how gaps in data collection, data analysis or cost accounting leads to unrecognized financial losses in laparoscopy and computer assisted surgery. This series draws upon CAVA Robotics extensive experience in assisting hospitals with their operating room clinical and financial data analysis and the lessions learned. Today’s discussion focuses upon unrecognized costs in computer assisted surgery that are either difficult to assess, impossible to ascertain or frequently neglected. For these reasons, they often are not considered in the “cost” of running a robotic program.
Several years ago, CAVA encountered a request from a hospital to evaluate costs that were not being fully represented in the financial analysis of each robotic surgical case. As a beginning robotic surgical program, scope repairs were frequent and reposable instrument dysfunction was high. The full breadth of the costs associated with the issue and the underlying factors influencing these events were unrecognized.
Together, we discovered that scope repair costs were underappreciated. Due to a multitude of factors including staff training, sterile processing and scope handling, the incidence of scope repair was much higher than anticipated. The total cost though of such repairs were very high. Scope repair provided by the vendor despite a maintenance contract approached $9k/incident and over $60,000/year!
Unfortunately, reposable malfunction was much more difficult to quantify. When an instrument malfunctioned, it was sent back to the vendor for evaluation. The vendor determined the reason for the malfunction and whether the unused “lives” of the reposable instrument remaining were able to be credited back to the hospital. In the cost accounting software and methodology of the hospital, keeping track of these incidents was challenging. Our own analysis of the reasons for instrument failure however revealed several things. Surgeon error and potential internal collisions were frequently a cause of instrument malfunction as indicated by things such as fracture of the “shaft” of the instrument. Perhaps more worrisome was that most of these events often went unrecognized during the operation. Another cause can be attributed to excessive or improper handling and processing of the reposable instruments. This brought to light important changes in turnover and sterile processing protocol that are important to maximizing the life of these reposables. The last cause is unknown in which a specific cause for instrument malfunction could not be found. This includes things like a cable being displaced, the instrument not responding well and the scissors not cutting well.
CAVA’s advice: avoid untracked costs of computer assisted surgery by keeping track of such “under the radar” costs and repairs. More importantly, have the processes in place such as handling of reposables and scopes in all departments such as the operating room and sterile processing because the consequences can be significant.