Forty Items, One Procedure: Costing Theatre Consumables
A caesarean consumes roughly the same forty items every time. Define that once as a pack and issue it as one thing, and you can finally say what a procedure costs — and see the stockout before theatre does.
There is a question every facility manager should be able to answer in one sentence and almost none can: what does one caesarean cost us in consumables? Not the tariff, not the theatre fee — the sutures, drapes, gloves, cannulae, syringes, gauze, catheter, spinal needle and the twenty-odd other things that leave the store every time. The reason the question is hard is not that the answer is complicated. It is that the store issues items and the theatre performs procedures, and until somebody writes down the translation between the two — the pack list — neither side can answer it.
The pack is the unit the clinical side actually thinks in
Theatre staff do not draw thirty-eight line items. They collect a pack. In well-run facilities that pack is physically assembled in advance — a labelled tray or bag, checked against a list, ready for the next case — and that practice exists for clinical reasons that have nothing to do with accounting: it is faster, it is safer, and a missing item is discovered at the bench rather than mid-procedure. The costing benefit is a free side effect of a discipline you should adopt anyway.
Which is why the accounting side should follow the clinical side rather than fight it. If theatre thinks in packs, the store should issue in packs, and the cost per procedure falls out of the arithmetic without anyone assembling a spreadsheet. When the two disagree — clinical staff collecting packs, the store recording thirty-eight unrelated issues — you get the worst of both: the effort of itemised recording and none of the insight. In AWRA the pack list is a bill of materials: the pack is an item, its components and their quantities are its lines, and the store issues against it.
The physical pack
A tray assembled and checked against a list before the case. This is a theatre discipline, not a software feature, and it is worth doing regardless of what you run.
A named list of what goes in it
A bill of materials on the pack item: each component and its quantity per pack. The pack page checks the list against a chosen warehouse for any number of cases and marks each line that is short.
Issuing the pack as one action
"Issue every component" raises a single pending check-out carrying every line for the number of uses you choose, approved like any other check-out. A quantity that would need half a component is refused rather than rounded.
Stock moving for each component
Each component decrements against a warehouse and location through the ordinary check-out, with the movement attributable and reversible.
A cost per pack
The pack page prices one pack at today's component costs. Packs built ahead into stock through an assembly order carry a moving-average cost that absorbs the actual cost of the components consumed.
Holding tomorrow's packs against today's stock
A manual hold with an optional expiry ring-fences stock so it cannot be issued, transferred or sold to anyone else; an hourly job releases expired holds. A theatre list is not a sales order, so placing the hold is a person's job, not the list's.
Two ways to record it, and they answer different questions
Issue every component on use
- One action per theatre list or per case: the check-out carries every component line, so the record survives a busy day.
- Stock figures stay genuinely accurate — every component decrements when it actually leaves.
- Each component goes through the same check-out as a loose issue, so batch and expiry are handled exactly as they would be for one item.
- Components leave at their current cost; the pack page tells you what one pack costs at today's prices.
- Nothing sits assembled in the system, so a pack physically made up on the tray is invisible until it is issued.
Build packs ahead with an assembly order
- Completing the order takes the components out and puts finished packs in, all or nothing, so the store holds twelve packs and correspondingly fewer gloves.
- The pack carries a rolled-up moving-average cost from the components it actually consumed.
- Component reordering keeps working, because the components really did leave the shelf when the packs were built.
- An unused pack can be unbuilt, which returns its components and shares the pack's cost back across them.
- The link from a specific component batch to the pack it went into is not carried through the build, so recall tracing to the case still needs the assembly sheet.
Neither is right for every theatre, and the choice between them is the actual decision this post exists to help you make. Issuing on use keeps the store's picture of the shelf literal and costs nothing to run; building ahead matches the trays your nurses physically make up and gives each pack a cost of its own. Most facilities land on the first for routine lists — one check-out per list, with the number of uses set to the number of cases — and the second only for the packs they genuinely assemble a day in advance.
You run a handful of procedure types at reasonable volume
Define the pack, issue it once per theatre list
Set the uses to the number of cases on the list and raise one check-out. Component-level stock and reordering stay intact, the approval step still applies, and cost per procedure comes straight off the pack page rather than from dividing a list total by hand.
Your consumables are genuinely pre-assembled and bought in as sealed kits
Treat the kit as the item
If a supplier delivers sealed procedure kits, the kit is the stock item and none of the above applies. Cost, expiry and reordering all work normally. This is the one case where the clean answer needs no pack list at all.
You make up trays a day ahead and want them on the books
Build the packs with an assembly order
Raise the order when the trays are made up and complete it when they are checked. The packs then sit in stock with their own cost, and an unused tray can be unbuilt back into its components rather than written off.
You need a defensible cost per procedure for tariff negotiation
Read the standard pack, record the additions
Take the standard pack cost from the pack page at today's prices, date it, and record only the per-case additions on top. That gives a distribution rather than a single average, which is what a payer conversation actually needs.
The variable layer is where the costing argument gets won
A standard pack is the easy half. The clinically interesting half is what gets added: the second unit of blood, the extra suture, the antibiotic switch, the case that ran ninety minutes over. If you cost only the standard pack, every complicated case looks exactly as cheap as a routine one — which means your average is wrong in the specific direction that matters, because complications are not distributed evenly across payers or across surgeons.
The practical control is to cost the standard pack once and record only the additions per case. That is a short list, it is clinically meaningful, staff will actually write it down, and it turns cost per procedure into a distribution rather than a single number. A facility that knows its caesarean consumables run from KES 8,400 to KES 19,000 with a median of KES 10,100 is in a completely different negotiating position from one that believes the answer is "about ten thousand".
What clinical staff call it What the system calls it
A C-section pack A bill of materials
A named composition of quantities of other items, priced from their current costs. In AWRA it lives on the pack item, and the store issues or builds against it.
Made up a pack for theatre An assembly order
Consuming components to create units of something else. Raising the order moves nothing; completing it moves everything at once, in one warehouse.
Reserved for tomorrow's list A manual hold
Stock ring-fenced so it cannot be issued, transferred or sold elsewhere, with an optional expiry. Someone places it; the theatre list does not.
Issued to theatre A stock check-out to a cost centre
A check-out adjustment against a warehouse and location, with a reason and an approval step before it applies — for one item, or for every line of a pack at once.
Cost per procedure A pack cost plus the additions
The standard pack priced at today's component costs, or carried on a built pack, plus whatever the case added on top.
| Capability | Sealed kit bought in | Pack built ahead | Pack issued on use |
|---|---|---|---|
| Stock figure is accurate | Yes | Yes | Yes |
| Cost per procedure is immediate | Yes | Yes | Yes |
| Component reordering works | Yes | Yes | Yes |
| Batch traceability to the case | Yes | No | Yes |
| Survives a busy theatre list | Yes | Yes | Yes |
| Matches trays made up in advance | Yes | Yes | Partly — configurable by you |
Built and maintained Configurable by you, not maintained by us Not built
The stockout you find in theatre
The operational cost of a stockout is not really the costing — it is discovering at the wrong moment that you have plenty of everything except the one item that makes the pack complete. A reorder point per item cannot see this, because each item individually looks fine. The pack page can: check tomorrow's list against the theatre store and it marks the component that is short. Run that check the afternoon before, place a hold on what tomorrow needs, and keep the physical discipline too — the empty tray at the bench is still the last line of defence.
What AWRA OpsHub does today
- A bill of materials for each pack, listing every component and its quantity per pack, checked against any warehouse for any number of cases with each short line marked.
- Issue every component in one action — a single pending check-out carrying every line for the chosen number of uses, through the same Pending → approved → applied lifecycle, reason and reference as any other check-out.
- Assembly orders that build packs into stock, all or nothing, with the pack's moving-average cost absorbing the actual cost of the components consumed — and unbuild to put an unused pack back.
- Manual holds with an optional expiry, so stock for tomorrow's list cannot be issued, transferred or sold elsewhere; an hourly job releases expired holds.
- Batch, lot and serial tracking on every component, with expiry date, supplier and originating purchase order held on the batch — so a recall traces to what left the store and when.
- Weighted average cost per item, maintained as stock moves and including landed cost, so the per-component numbers the pack is priced from are sound.
- A hard refusal when stock is insufficient. A component that is not there cannot be issued, with the reason stated — no negative stock and no silent override.
More we can add to your workspace
- Holds placed from a theatre list. A list or booking that ring-fences its packs automatically, the way a confirmed sales order reserves its stock today.
- A procedure or case record for a cost to attach to. The nearest dimension on a stock issue is a project, which is why a standing project per theatre or per procedure type is the current way to group it.
- A pack-level reorder point, so the store is told when it can no longer make up tomorrow's packs rather than checking the pack page by hand.
- Consumption variance against the pack — expected versus actual use per case, the comparison that catches waste, over-issue and leakage.
- Batch genealogy through a build, linking each component batch to the packs it went into, for recall tracing to the patient.
This is the same layer a hotel uses for recipes, and it lands harder here because a theatre stockout is a clinical event rather than an annoyed diner. The pack itself — list, one-action issue, build, cost, hold — is in the product. What sits on top of it, tying a pack to a case and measuring the case against the pack, is the part we can add for you.
Anything above that you need, we can build for you
Everything listed above as something we can add describes what ships in the standard product today — it is a starting point, not a limit on what AWRA OpsHub can do for your organisation. Kenya's eTIMS integration and its maintained payroll engine are both in the product because clients needed them and commissioned them; neither appeared by itself, and the same door is open for whatever you just read about. One qualification so this is worth what it claims: a small number of things on this blog we deliberately leave to a specialist rather than build — a statutory ledger we will not sign our name to, a rule that would decide a tax question for you, a clinical or member-funds record that belongs in a regulated system — and where that is true the post says so in those words. Everything else is a scope, a timeline and a price.
The operational work, which is what most commissions actually are
An extra approval stage in a chain that does not match the standard one, a custom field set on employees or assets that only your sector needs, an expiry that has to block an order rather than send an email, a report your board asks for in a shape nothing produces, or a scanner or weighbridge feeding the goods-in door. These are the commissions we are asked for most often and the smallest ones we quote — and unlike a revenue-authority pipeline, none of them waits on a regulator.
The module-shaped additions, which are the ones readers ask for most often
A price list with real discount authority, a customer-facing quotation that expires, a bill of materials or recipe costing, a staff advance that is issued, acquitted and chased, a member or unit ledger, a matching rule that holds a payment. Each of these is a build rather than a setting, and each has been quoted before — a bigger piece of work than a custom field, with a written spec and a date instead of a roadmap slide.
The report, document or pack nothing currently produces
The board pack in the shape your board actually asks for, a donor or funder layout, an invoice or receipt template carrying what your regulator or your customer expects, a dataset the report builder cannot reach yet. Usually the fastest thing on this list to deliver, because the data is already in the system.
Systems, rails and hardware you already run
The accounting package, CRM, online store, core banking or custom database you intend to keep — connected through our API so a fact is entered once and appears everywhere it is needed. Plus the physical edge: a scanner, a scale, a weighbridge or a till peripheral feeding the door it belongs to.
How it works: you describe the requirement, we return a written scope, timeline and cost, and once agreed it is built into your environment and maintained as part of the product. Nothing here waits on a regulator or a published specification, which is why operational builds are the ones we quote fastest. Tell us the requirement that would otherwise rule us out — that is a better first conversation than a demo.
Tell us what your operation needsThe short version
Define each pack once, issue it once per theatre list, and record only the additions per case. The standard pack gives you a cost; the additions give you the distribution you actually need — which a single standard cost never would.
The consumables in the pack are also the items most likely to expire on a shelf, so this sits directly on top of expiry management and the FEFO discipline that governs which batch leaves first. And once you know a procedure's consumable cost, cost per visit is the framework that turns it into a tariff position.
Control what leaves the store
Procedure packs as bills of materials, one check-out for every component, packs built ahead with a rolled-up cost, holds for tomorrow's list, batch and expiry on every component, and a hard stop when stock is not there.
See clinic stock control in AWRAFrequently asked questions
What is a procedure pack in inventory terms?
It is a bill of materials — a named composition of specific quantities of other stock items, with a cost derived from theirs. In AWRA the pack is an item with a bill of materials on it, and the store can either issue every component in one check-out or build packs into stock with an assembly order.
Should we treat the pack itself as a stock item?
If you buy it in sealed from a supplier, yes, and nothing else is needed. If you assemble packs in-house, make the pack an item with a bill of materials and choose per pack: issue the components on use, or build packs ahead with an assembly order. Building takes the components out as it puts packs in, so component stock figures and reordering stay correct either way.
How do we get a defensible cost per procedure from a pack?
Define the standard pack as a bill of materials and read its cost at today's component prices from the pack page, or let a built pack carry its rolled-up cost. Then record only the per-case additions — the extra suture, the second unit of blood. That gives you a median and a range rather than a single average, which is both more honest and more useful in a tariff negotiation.
Why does an average cost per procedure mislead?
Because it hides the variable layer. Complications are not evenly distributed across payers, surgeons or times of day, so a single average is wrong in whichever direction your case mix leans. A facility that knows its caesarean consumables run KES 8,400 to KES 19,000 with a median of KES 10,100 can negotiate; one that says "about ten thousand" cannot defend the number when challenged.
Can we reserve stock for tomorrow's theatre list?
Yes, by hand. A manual hold ring-fences the stock so it cannot be issued, transferred or sold to anyone else, and it can carry an expiry so an unused hold releases itself. A theatre list is not a sales order, so it does not place the hold for you — someone checks the list against the pack and places it.
How do we catch a pack that is short before we are in theatre?
Open the pack, enter the number of cases on tomorrow's list and the theatre store, and the pack page marks every component that is short. Do it the afternoon before. Assembling trays a day in advance is still worth keeping as the physical check at the bench.
Does batch traceability survive if we pack in-house?
If you issue the components on use, each component leaves through the ordinary check-out, so its batch is recorded as it would be for a single item. If you build packs into stock, the link from a component batch to a particular pack is not carried through the build, so for implants and blood products record the batch numbers on the assembly sheet and keep it.
