What are surgical preference cards and why is accuracy important?
Individual surgeons operate in different ways, and require different supplies for procedures. In facilities that perform hundreds of surgeries weekly, physician preference cards are integral for keeping teams informed of supplies that are needed from stock. This ensures surgeons have exactly what they need when they need it, facilitating quicker, safer procedures. Preference cards can also minimize waste in both materials and spending when only necessary supplies are used during procedures and patients are billed accurately.
Keeping preference cards accurate as surgeon preferences change is challenging, with manual revisions prohibitively labor-intensive and time-consuming. Poorly kept cards cause a variety of issues, such as excess supply stock, prolonged anesthesia times, reduced safety when staff leave the OR to retrieve missing items, and waste of incorrectly pulled supplies and equipment.
There is a large body of work on improving surgical preference cards through manual, ad-hoc efforts, such as revision by a committee of experts or incentives for surgeons to lower costs. However a recent systematic literature review found no fully data-driven, automated efforts to optimize surgical preference cards.
In a single center study*, using electronic health record data to optimize surgical preference cards was associated with reduced surgical supplies costs.
A prospective, case-controlled study in a single-institution, multi-departmental academic pediatric setting used a control group that included surgeon-procedure specific preference cards (n = 408). For each item on a preference card, the appropriate quantities to be provisioned and opened were estimated using EHR data from the pre-intervention period (June 1, 2016 – February 28, 2017).
During the intervention period (March 1, 2017 – May 31, 2017), one surgical nursing leader for each surgical service used these estimates to edit preference cards. The direct cost of surgical supplies over the post-intervention period (Jun 1, 2017 – Aug 28, 2018) was compared to that from the pre-intervention period.
There were, respectively, 1,081 and 1,493 control case and 1,777 and 3,106 intervention pre- and post-intervention cases.
Results: The average direct cost of supplies per case decreased 8.38% in the intervention group and increased 13.21% in the control group.
This corresponded to a procedure-adjusted direct cost decrease of over 1 million dollars for intervention cases and an increase of $604k in control cases.
The average number of items added to and removed from preference cards were, respectively, 1.5 and 0.9 for control cases and 5.1 and 4.2 for intervention cases, indicating that the use of EHR data allowed for increased, more effective changes to preference cards.
Anecdotal reports at the institution studied, supported by numerous studies, indicated that inaccurate preference cards were contributing to high costs and delays, but that the process of revising them was prohibitively labor-intensive and time-consuming.
Findings demonstrated that using EHR data to optimize surgical preference cards required less effort than would have a manual intervention and was associated with a significant reduction in direct surgical supply costs.
This intervention and the results found, led Carta Healthcare to develop Darwin, which provides service leads with compelling data and evidence for recommendations for effective preference card updates.
*Article sites the paper titled: “The Use of Electronic Health Record Data to Optimize Surgical Preference Cards”, used with permission and authored by:
- David Scheinker PhD, Stanford Engineering and Lucile Packard Children’s Hospital Stanford
- Matt Holligsworth MBA, Standford Graduate School of Business, CEO Carta Healthcare
- Anna Chukaeva MBA, Standford Graduate School of Business, COO Carta Healthcare
- Carey Phelps BS, Stanford Engineering
- William Bryant RN, Montefiore Medical Center
- Francesca Pei PhD, Lucile Packard Children’s Hospital Stanford
- Kristin Petersen MBA, Lucile Packard Children’s Hospital Stanford
- Alekhya Reddy, BS Product Manager Carta Healthcare
- James Wall MD, Lucile Packard Children’s Hospital, Stanford Department of Surgery