TIME WELL SPENT Rhonda Kaiser, RN, and Sara Irby, RN, specialty coordinators at University of Colorado Health, take a few minutes to review physician preference cards.

If you've been putting off updating your physician preference cards, don't delay any longer. It's a time-consuming chore, yes, but the rewards will be well worth it. Your nurses and scrub techs will spend less time tracking down missing supplies, and your surgeons will grumble less about supplies missing from the OR. After several years of avoidance, we recently reviewed our hospital's preference cards (see "Accurate Preference Cards Pay Big Dividends" on page 24). Here's some helpful advice for when you finally start pulling cards for review.

Identify the issues
Survey your staff before beginning the process. Do they find preference cards helpful? Do they use certain sections of the cards more than others? We learned that our staff didn't trust the outdated cards and instead relied mostly on their memories of what surgeons always ask for when pulling supplies for cases. We learned from them what needed to be noted and what could be eliminated. Standardizing the language used on the cards and streamlining the supplies noted made the cards easier to read and understand, which ultimately made them more useful. Understanding the issues staff face will help you focus on an improvement process that works.

Start big
First address the cards for the highest-volume procedures you host, because reviewing supplies used during those cases will have the biggest initial impact on your bottom line.

Assign specialty leaders to review the cards for the 10 highest-volume procedures in their service lines. Create a standard agenda for the leaders to meet with individual surgeons, who might not even be aware of what is noted on their cards. Have them ask the physicians if the cards are still accurate and if they're still using all the supplies noted. During this process, one team leader at our hospital found out that we hadn't updated suture requests in quite some time. In fact, we had specialty suture on our shelves requested by surgeons who were no longer practicing at our facility.

Give the specialty leaders about 3 months to review the preference cards and meet with surgeons, and monitor their progress to ensure they'll meet the deadline. Our electronic medical records made auditing the process easier by letting us review when preference cards were updated.

Capitalize on the face-to-face meetings to educate surgeons about cost-effective, clinically equivalent supply and equipment options. Challenge them to make changes in order to standardize as many supplies as possible, which gives your facility more negotiating power with supply and equipment vendors. Most physicians will hopefully realize they have to bend a little on their requests for the overall financial benefit of your facility, especially in this era of healthcare reform cost-saving initiatives.

Make additional upgrades
When new surgeons arrive, don't copy the preference card from another surgeon in their specialty group. Instead meet with the surgeons to understand their individual preferences and build cards specifically for them.

Define "open" versus "have available" on preference cards, and make sure staff understand the difference. During our initial review of the preference card process, we discovered staff members were opening many items that weren't necessarily needed because of what was noted on the cards.

Consider training a surgical nurse to audit perioperative documentation and ensure supply charges are captured accurately. The nurse can also provide on-the-spot education if members of the surgical team mistakenly note the use of incorrect supplies. We revamped the position to include some coding to help ensure charges match what was actually used in the OR. You want accurate records, especially after all the effort you put into updating the preference cards.

FINANCIAL GAIN
Accurate Preference Cards Pay Big Dividends

ACCURATE & CURRENT This physician preference card was updated last month.

It had been years since we checked to ensure our preference cards were up to date and accurate. There was no expectation or accountability for staff to keep cards updated, and no formal process in place to personalize cards for new surgeons who came on board. Does any of that sound familiar? If it does, follow our lead to realize some big-time financial gains like these 6 staggering figures our hospital realized simply by reviewing and updating preference cards:

• decreased suture inventory by $88,000;
• reduced the value of annual supply donations made to Project C.U.R.E., the largest provider of donated medical supplies and equipment to developing countries around the world, from $270,000 to $100,000 (we want to help facilities in third-world countries, but need to do so while being fiscally responsible);
• reduced unused preference cards by one-third over 3 months, which slashed staff workload by 21%;
• shaved 70 hours per month off the time nurses and scrub techs spend tracking down missing supplies, which translates into a $21,000 savings in annual staffing expenses;
• reduced supply costs by $32,500 by removing such standardized supplies as gloves and gowns from preference cards and instead storing them in our ORs; and
• reduced the number of calls for missing supplies from 30 per day to 18, which lowered the number of case interruptions and improved surgeon satisfaction.

— Treena Dockery, MBA/HCM

Stay up to date
Understand that keeping preference cards current is an ongoing process. To get the most out of your cards, review them at least quarterly. You might groan at the thought, but the initial review and update of the entire collection of cards is the biggest challenge. Subsequent reviews will be easier and faster if you're constantly staying on top of the process. OSM