Ensuring patient safety and reducing medical waste rely on accurate surgical preference cards.
A surgical preference card outlines the supplies, tools, and room setup that a surgeon needs to safely perform a particular procedure. Having the correct supplies available for a surgical procedure is crucial to ensuring safe, efficient surgeries, yet most cards are out-of-date and inaccurate. The physician preference card began as a handwritten index card with the surgeon’s name, procedure name and a list of supplies. All changes were made in writing. Maintenance of the cards was time-consuming and tedious, leading to messy, outdated preference cards.
Later, preference cards evolved into computer generated lists that could be printed and used as pick lists. The computer generated lists still had to be updated manually and were not integrated with other supply chain software. Today, many hospitals are managing preference cards by electronic health records (EHR) software in conjunction with some strategy of preference card standardization. Although various software have preference card modules, there is still a need for updates within multiple systems that do not interface.
Improving the accuracy of the preference cards through digital strategies can decrease costs, improve efficiencies, and improve quality outcomes, according to PwC analysis:
- Decrease supply costs. PwC estimates that 3-5% of overall supply cost for perioperative and interventional cases is supply waste due to lack of maintenance and management of physician preference cards. Higher inventory levels and additional stocking locations increase holding costs, stockouts and risk of expiration.
- Improve quality outcomes. Eliminating the need for the Circulator to leave the OR to retrieve missing items can impact and improve patient safety and quality.
- Improve efficiencies. Accurate preference cards can improve OR efficiencies by decreasing late starts and case delays that cause adverse impacts on patient throughput and case progression. Reducing the inefficient use of labor (including RNs) picking, packing, delivering, and restocking excessive items will decrease labor costs and unburdening clinicians.
Surgeons can own and manage their preference card through a mobile app allowing them visibility into items used and total cost per procedure. Surgeons will be presented with cost comparative reports such as percentile of cost performance relative to peers and visibility into preference cards of low-cost providers. Additionally, the digital preference card can be interactive providing prompts and suggestions for cost improvements. The digital preference card monitor usage of supplies and prompt the surgeon to delete or reduce items not used, identify items to be placed on standby/hold status, and promote items that should be added to the card based on procedure use.
Key success measures
Implementing a successful digital preference card management process can improve efficiencies, lower cost and improve staff satisfaction:
- Elimination of waste from open and unused products, decreasing costs
- Ability to decrement inventory supply and reorder items that have been used in the case
- Integration of item master and preference cards systems to show accurate product purchase price
- Realtime feedback of supply cost per case as compared to internal / external benchmarks
- Easy access for realtime update to preference cards by surgeons and staff
Approach to digital preference card management
Developing a successful digital preference card management program begins with a governance structure to develop goals and objectives, drive the approach to cleaning up the cards and monitoring metrics to determining a multi-channel approach to digitalize:
- Establish governance structure
- Establish clean up criteria/approach
- Map procedural file to standardized nomenclature
- Map preference card to standardized procedural file
- Eliminate redundant and infrequently used procedure cards
- Prioritize management of preference cards with surgeons (80:20 rule)
- Develop policy for ongoing sustainability
- Establish metrics/KPI dashboard
- Roll out digital capabilities for ongoing management and sustainment
Contact:
Patrick Voight, RN, CNOR, Managing Director, PwC US
Jane Evens, RN, Director, PwC US
Thom Bales, Principal, PwC US