A tray can be used once and still create a week of operational work. It can be packed for a case, sent to the wrong facility, held as a backup, returned incomplete, routed through sterile processing, and shipped again before anyone records a procedure against it.
That is the blind spot in many tray utilization reports. They tell a hospital, manufacturer, distributor, or 3PL whether an asset supported a case. They do not necessarily show how often the asset had to be located, staged, transferred, inspected, sterilized, returned, or chased.
New U.S. research makes the scale of the underlying problem harder to ignore. A study of 251 healthcare facilities and 2,618 operating rooms analyzed 336,784 trays and 6.7 million instruments. The authors estimated nearly 4 billion annual instrument reprocessing events across U.S. hospitals and annual sterilization costs ranging from $1.3 billion to $11.8 billion, depending on the cost assumptions used. The study in BMC Health Services Research is not a loaner-tray report, but its operational lesson reaches well beyond owned hospital inventory. (link.springer.com)
The next tray audit should therefore ask two separate questions: was this asset used, and what work did the network perform to keep it available? Combining those questions too early produces bad decisions about ownership, fleet size, routing, and the value of visibility.
Utilization is not the same as movement
Utilization is attractive because it appears simple. A total joint set supported 18 cases last quarter. A shoulder set supported 4. A spine tray was not opened at all. From there, an organization may decide to buy more of the first set, reduce the second, or eliminate the third.
But a procedure count does not describe the path an asset took to reach the procedure. The shoulder set may have moved between 3 hospitals and 2 ASCs, arrived as a backup for 5 cases, gone through decontamination twice, and returned to a distributor between scheduled dates. The spine tray may have been held at a 3PL, sent to a field representative, transferred to a hospital, and returned because the case was canceled.
None of those movements necessarily appear in a conventional utilization report. Yet each one consumes labor, transport capacity, receiving time, sterile processing capacity, or attention from a field team.
This distinction also changes how a health system evaluates owned versus loaner inventory. An owned tray that sits in a local storage area may have high clinical utilization and low network movement. A loaner tray with lower case utilization may be doing more operational work because it is constantly routed among accounts. Looking only at cases can make the first asset look expensive and the second look efficient, when the movement pattern suggests the opposite.
That is why a useful asset record needs to show more than whether a tray is present. It should make the movement history visible across the warehouse, hospital, ASC, sterile processing department, and field team. Hansel’s real-time tracking is built around that shared picture, so teams can see where trays and loan sets are moving instead of reconstructing the path from separate spreadsheets, scans, and messages.
The cost is often created before and after the case
The most expensive part of a tray’s life may not be the moment it is opened in the operating room. It may be the work required to make the case possible.
Before the case, someone confirms the procedure, checks the required set, verifies that the inventory is at the right site, and determines whether the tray is ready for processing or already available for use. If the record is incomplete, the work becomes a series of calls: ask the rep, check receiving, search the clean room, review the last barcode scan, and decide whether another set should be shipped.
After the case, the same asset enters another uncertain stretch. It may be opened but unused. It may be missing an instrument. It may be sent to decontamination. It may be wrapped and waiting for a return pickup. It may be sitting in a field vehicle because the next account needs it. A case count does not explain which of those states applies.
A 2026 performance summary from The Joint Commission illustrates the other side of the problem. Saint Alphonsus Medical Center in Idaho standardized robotic surgery trays by identifying core instruments used in most cases and redesigning the workflow with frontline staff. The organization reported faster robotic case turnovers and less sterile processing rework. (digitalassets.jointcommission.org)
Tray redesign is not the same project as asset tracking, but the two decisions depend on the same operational truth. Leaders need to know what is actually used, what repeatedly moves, and what gets reprocessed without contributing to patient care. Without that separation, a team can remove instruments from a tray while missing the larger problem of sending the wrong tray to the wrong place, or keeping too many sets in circulation because no one trusts the location record.
Movement data turns a fleet decision into an operating decision
For distributors and manufacturers, movement data can expose a different kind of utilization problem. A tray may not be clinically used, but it may be tied up in the network for days. It may be sitting at a hospital after a canceled case, waiting for a rep to retrieve it. It may be at a 3PL with no confirmed next destination. It may be in transit while another account is preparing an emergency shipment for the same procedure family.
Those are not merely logistics exceptions. They affect how many sets the organization needs, where the sets should be positioned, and whether a shortage is real or created by poor visibility. A manufacturer that sees only procedure use may add inventory. A manufacturer that sees use alongside movement may find that the better answer is faster returns, clearer routing, or a more reliable view of which assets are available at each site.
The same logic applies to hospital networks. A health system may own enough trays for its orthopedic program and still experience delays because the assets are distributed across campuses without a dependable live picture. The answer may not be another purchase. It may be to understand which sets are stationary, which are circulating, and which are unavailable because their current location is unknown.
Per-asset tracking also matters economically because it keeps the conversation tied to the actual fleet. The question is not whether every employee needs another login or whether every department needs a new dashboard. The question is whether the cost of visibility is justified by fewer lost sets, less searching, better utilization, and fewer avoidable transfers. A system that cannot be evaluated against those outcomes becomes another line item. A system that shows the movement of the assets creating the work can be measured against the operational burden it is meant to reduce.
Hansel’s case scheduling and inventory auditing capabilities fit into that operating view. A team can compare the trays required for upcoming procedures with where those assets are recorded, then review movement and availability over time. That does not replace sterile processing release procedures, quality records, or local accountability. It does give operations, field teams, and clinical partners one place to see whether an asset is moving toward a case or simply moving through the network.
The better benchmark is use per movement
Most organizations already know how to ask how many cases a tray supported. The sharper benchmark is how much movement and reprocessing the tray required per case, and how much of that work produced no case at all.
That measure does not need to be perfect on the first attempt. Start with a scarce orthopedic set, a high-volume ASC route, or a loaner fleet that repeatedly creates late calls. Compare procedure use with transfers, staging events, return delays, and time spent locating the asset. Then separate clinical utilization from operational circulation.
The result may show that a low-use tray should be retired. It may show that the tray is essential backup inventory. It may show that the asset is not the problem at all, and that the network is paying repeatedly to compensate for not knowing where it is.
The important shift is conceptual. A tray is not just an instrument container that is used or unused. It is a moving asset with a cost before the case, during the case, and after the case. Until those movements are visible, utilization reports will continue to describe only the last step of the work.
