“Preference cards are actually low-hanging fruit for any hospital that’s serious about reducing its costs and improving efficiency. All it takes is an initial effort to clean them up so they reflect OR reality, and the discipline to maintain the cards’ integrity and currency over the long term.” – Becker’s Hospital Review Article written by Steve Simco and David DuBose
The Importance of Preference Cards
Preference cards are a critical component of successful surgical department operations. While traditionally stored on paper, most modern EMRs contain functionality that allow them to be digitally stored and managed. Preference cards contain the equipment, materials, and instructions needed to perform a case. Accurate preference cards simplify the process of acquiring the necessary materials for a case, allowing clinical staff to focus on the most important thing: the patient. Surgeons can be confident when they walk in to an OR that everything they need to complete that case will be present if their cards are up to date. Nursing staff review preference cards for important set up and positioning information. Central Processing and Inventory departments can better determine instrument and material demand for upcoming cases using the information provided within preference cards. Without accurate, optimized preference cards, completing all the scheduled cases becomes significantly more burdensome.
The Challenges of Preference Cards
For all the important information that preference cards provide, it’s hard to deny the fact that maintaining them can be difficult and resource consuming. Once preference cards become out of date it can feel like a seemingly impossible task to correct them. Inaccurate preference cards can be a large source of waste in the OR department. Missing materials can cause delays in a case, as staff needs to leave the room to collect the items. Delays in a case can not only disrupt the current day’s schedule, but also impact future cases, if historical durations are used to determine case length, and minutes spent getting materials are attributed to case time. Unnecessary materials brought in to an OR room result in excess time spent by staff putting the materials away. This also leaves times when items are not on the inventory shelf and will eventually be returned. If inventory management processes and systems don’t account for this, then while an unneeded item is sitting in an OR room, additional materials might be unnecessarily ordered.
Why are preference cards so hard to maintain? The causes can be broken down into three different categories: people, processes, and technology.
People: OR departments need to devote resources to the task of maintaining preference cards to ensure . Without these resources, when nurses and other clinicians have the choice between caring for a patient, and editing the preference card, they’ll (rightfully) pick the patient every time. If someone is given dedicated, protected time to work on preference cards, it’s much more likely the necessary work will be done.
Processes: Is there a defined process at your institution on how preference cards are to be created, maintained, and removed? Not just a standard operating procedure that is written down somewhere, but a process that everyone knows, and understands their role. A process that makes sense and fits in to the workflow of those who are expected to use it. While ideally, surgeons and nurses would have thoughtful conversations about preference cards outside the OR, perhaps the ideal time to talk about what a surgeon needs for a case is in the room after that case. Submitting a correction or update for a preference card should be simple if it’s expected to be done.
When asking our clients about current state processes, we may get many different answers within the same institution, “there is no process”, “there is a process, but no one is assigned to it”, “we have a process and it’s X,Y,Z”. A well-defined process that no one utilizes might as well not even exist. ORs are busy places, so any process implemented must fit in to the current workflow as much as possible.
Technology: Preference cards have come a long way from their paper origins. Most can link directly to an inventory system to add items directly from the inventory list. By analyzing preference card contents, IPS has worked with clients to create reports comparing surgeons’ cards to identify opportunities for standardization. These reports can spark a conversation among surgeons as to why some use different, possibly more expensive, materials than other. Another way analytics can be leveraged to help in preference card clean up, is to identify items that are consistently not used during a case to remove them from preference cards, using charge capture data.
The Detail Work Facilities Can Do
Tackling this daunting problem doesn’t—and shouldn’t—be merely hours of manual work. There are ways to leverage analytics and smart processing to ease some of the pain of updating and managing preference cards. First, start with looking at your current preference card inventory. Are some never used? Don’t waste time updating cards that won’t see the light of an OR suite again. Can some be combined, because two or more procedures use identical equipment and materials? Depending on the EMR used, it can be flexible enough to allow a reduction in the number of cards.
Treating preference cards like the valuable resource that they are, and devoting time and energy to keeping them up-to-date is a great way for a facility to achieve a better optimized surgical department, and create cost savings in the form of less wasted materials and movement, and a more efficient use of OR time.
About the Author
Lauren Wolf has been with IPS as a healthcare analyst since 2014, with experience working on projects in both ancillary and main hospital services, including Lab, Radiology, Main OR, and Infection Control. Using tools such as SQL and R, and abilities gained from her Management Information Systems degree, she has produced compelling, informative, and actionable data analysis and visual aids. Prior to joining IPS, she worked in the health insurance and manufacturing sectors.