Doctor Preference Cards: A Recipe for Success
Written by Ann Putnam, RN, MSN, CNOR
Every day all types of surgeries are scheduled and carried out in operating rooms across the country. How do the staff know the unique surgeon preferences for each of the procedures on the surgery schedule? How does the perioperative team know what to open and when to hold items until needed? How is the department efficiently organized to support pulling the supplies and equipment needed for those surgeries? How are inventory levels properly managed to avoid waste? What’s the recipe for a successful surgery?
Today’s process is integrated within most of the universal Electronic Health Records (EHR) and can list the necessary equipment, instruments, and single-use supplies needed for a specific procedure. Surgery departments commonly utilize Doctor Preference Cards (DPCs) to help guide the equipment, instruments, and supplies needed for a specific procedure by a specific physician. These cards can also be referred to as Physician Preference Lists, Procedure Cards, Resource Cards, Pick Lists, or simply Cards – like a recipe card. Without a dedicated maintenance process, these preference cards can be a plague to healthcare organizations – cases are delayed, the wrong items are picked, unnecessary supplies are opened and unused! No matter what state of accuracy your department’s preference cards are in, they are still being used during every surgery.
Lowering Costs/Reducing Waste
Updated Doctor Preference Cards should reflect the current items necessary for a procedure. Almost 30 percent of items pulled before surgery go unused.1 Imagine the waste this creates. Often, many items that are unused are simply thrown away. Another opportunity to reduce costs is to identify variation between surgeon preferences for supplies used for the same procedures. Our healthcare system allows for a considerable amount of physician preference in clinical decisions within a broad range of acceptable practices. This “preference” bleeds its way into requested items for surgery causing significant complexity and cost variance. Some of this variation can be addressed through a Doctor Preference Card analysis, but physician engagement and willingness to adopt change is drastically improved when the variation review includes a correlation to quality and outcome measures with direct cost transparency.
Patient safety during surgery is directly impacted by having the right supplies, instruments, equipment and medications at the right time. This preparedness enables the surgical team to focus on the patient rather than searching for needed items. The risk of complications, longer anesthesia times, case delays or even cancellations rises when needed supplies are not available. Additionally, a department with poorly maintained DPCs is at risk for having a high turnover of staff related to the challenges associated with working without the proper tools and resources for their job. Teamwork is essential for patient safety; high performing teams consist of experienced, high functioning employees who trust one another. When a DPC process is optimal, the entire surgical team is available to focus on the safety of the patient.
Impact to Operational Efficiencies
Accurate DPCs support operational efficiencies from the beginning of the scheduling process through to billing. With updated DPCs and accurate scheduling there is an improved likelihood of optimizing inventory2. When a DPC pick list is referenced, the surgical case carts can be accurately pulled prior to the case, ensuring the right supplies are ready for use. Confidence that the necessary supplies are available supports avoiding procedure cancellations, delayed on-time starts and lengthy turnover time. DPC accuracy assures the correct supplies are available on each individual case cart and reduces the amount of supplies returned for re-stocking or wasted in the OR. Eliminating this type of waste not only saves money, but it improves teamwork and employee satisfaction.
Development and implementation of a DPC maintenance process is critical to the accuracy and completeness of what is opened and used for every surgery. Collaboration between all members of the surgical team, supply chain, surgeons and anesthesiologist are crucial to an effective and safe process. An improved process for maintaining DPCs will enhance operational and financial benefits, improve surgeon satisfaction, support a culture of safety within the OR, and promote the competency of all surgical services staff for the department!
At Empiric Health, we know that Doctor Preference Card accuracy and optimization is crucial to identifying and reducing unwarranted clinical variation in surgery. By optimizing workflows that promote staff engagement, one of our clients identified over $2.5 million worth of supplies that were unnecessary during the initial phase of preference card clean-up. In addition, they found $1.3 million more in the 2nd year by implementing a defined process.
Are Doctor Preference Cards being optimized in your Operating Room? Have you explored the value of the difference between a preference card and a procedure card? To continue the conversation, email us at firstname.lastname@example.org or learn more about what we do at www.empirichealth.com.
Preference Card Management: Improving Clinical Efficiency and Patient Care; research study and CME provided by Cardinal Health (2012)
Schmidt, R. N., Posteraro, R. H., & Lopez, M. (2019). Reducing Waste in the Operating Room through Inventory-Based Supply Chain Optimization. Journal of Business & Behavioral Sciences, 31(1), 74–83. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=bth&AN=137227632&site=eds-live&scope=site