Centura Health updated over 16,000 physician preference cards that had not been revised in 7 years. They took a hybrid approach, first working with a consultant to refresh the cards and establish an update process, then transitioning management internally. Key changes included adding a hold column to reduce waste and moving items out of notes to ensure billing. Meetings with each surgeon to review edits resulted in positive feedback. Updating the cards saved $3.2 million in the first year. UPMC Presbyterian Shadyside Hospital standardized card formats across specialties and reduced items per card by 15 on average, decreasing restocking time by 10 minutes. Both organizations emphasized leadership support, engaging clinical staff, and differentiating between opened and held supplies

1. OR Manager
Vol. 32 No. 3
March 2016
1
E
ven the most experienced OR leaders often view physician preference cards
(PPCs) as a beast that acts out and demands attention at the most inconvenient
times. Two organizations that have managed to tame the PPC beast shared their
experiences with OR Manager.
Updating cards saves more than $3.2 million
Tresa Osborne, BS, RN, CNOR, system director for clinical value analysis at Centura
Health Supply Chain in Denver, faced a challenge. The PPCs for the 16-hospital sys-
tem hadn’t been updated in about 7 years, and a planned switch to a new electronic
health record system (Epic) meant cards needed to be revised before transferring to
the new system.
“We took a hybrid approach,” Osborne says. She and her colleagues at Centura
(senior supply chain analyst Terry Walb, RN, and value analytics analysts Jesselyn
Taggart, MHA, and Pernilla Paquette MBA, MS) first worked with Deloitte to refresh
the cards and put an update system in place. Now Centura staff manage the entire
process.
Lesia Very, MSN, RN
To start updating the cards, clinical coordinators (called assistant nurse
managers) for the service lines reviewed copies of current cards that
had been placed in a binder for easier access. One of the first changes
identified was the need for a hold column so that fewer items would be
opened. “This results in a big savings by avoiding waste,” Osborne
says.
The clinical coordinators also found too many items listed in the
“notes” section of PPCs, which meant they were not identified for bill-
ing. This section was deleted, and each item moved under the appro-
priate category: drapes, sutures, or gloves. OR directors voted on what the categories
would be.
Once the clinical coordinators had annotated the books with the updates, Osborne
and her colleagues scheduled “surgeon fairs”—one-on-one meetings with each sur-
geon. “We sent a letter to let them know what we were doing and why,” she says.
The letter was signed by the CEO and the chief medical officer to signal the support
of upper leadership.
“These big initiatives need a push from the top down,” says Osborne, who credits
the success of the meetings to the clinical coordinators’ willingness to accommodate
each surgeon’s schedule. The coordinators reviewed the edits in the book with each
surgeon.
“At first [surgeons] complained that they didn’t have time, but when they saw
how everything was ready to go, they gave a lot of positive feedback for the pro-
cess,” Osborne says. The meetings were scheduled for 1 hour, although some ran
longer or a subsequent meeting was planned.
Data entry came after the surgeon review. Because of the clinical coordinators’
busy schedules, in some cases Centura hired temporary workers to enter the data,
which the coordinators then checked.
To maintain PPCs, Centura hired a full-time OR nurse to take the lead. Staff re-
quest a change by completing a template available on the hospital’s intranet. If the
PPC nurse approves the change, it’s made within 3 business days, with 1 day being
most frequent.
“We took away mass edits [of PPCs] because they’re often done incorrectly,” Os-
Performance improvement
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2. OR Manager
Vol. 32 No. 3
March 2016
2
borne says, noting that only the PPC nurse is
able to make global changes. Adding the po-
sition was easily justified by the $3.2 million
saved over the first year.
In addition, supply chain directors in the
hospitals post a placard where a supply item
is located to notify clinical coordinators that a
conversion is in progress, so they can request
a change in the card. The PPC nurse then veri-
fies the item has been approved and ensures
it has a billing number assigned. Osborne
adds that the Epic dictionary can be shared
with the billing system.
“It’s imperative that directors and senior
leadership encourage clinical coordinators to
get the work done,” Osborne says. “Staying
on top of it is huge.”
Increased satisfaction
A survey of the OR staff at UPMC Presbyterian Shadyside Hospital in Pittsburgh,
Pennsylvania, identified outdated or inaccurate information (noted by 95% of re-
spondents) and inconsistent formatting among specialties (noted by 90% of respon-
dents) as the biggest frustrations related to PPCs, according to Lesia Very, MSN, RN,
unit director.
Very and her colleague Sherri Jones, MS, MBA, RDN, LDN, FAND, quality im-
provement specialist, presented a poster on their experience with PPCs at the annual
OR Manager Conference in October 2015.
Service line coordinators (clinicians) are in charge of updating the cards, so Very
worked with them in creating a better process. This included involving team mem-
bers to update and design a more standardized format, and the simple changes re-
sulted in significant time savings.
Very admits it can be a challenge to get staff to see updating PPCs as a priority.
“Emphasize that it’s important to do this because of the costs associated with each
procedure,” she recommends. “People aren’t aware of how much things cost, so we
let them know.”
She also emphasizes the importance of differentiating between which supplies
need to be opened and which ones can simply be available in the room.
“The service line coordinators worked on standardizing the card format,” Very says,
adding that the conversion to the standard format took several months (sidebar above).
The cards are computerized and linked to the sterile processing department (SPD).
Standardization, along with the introduction of custom supply packs for common
procedures, helped reduce the number of items on each card by an average of 15. In
turn, the time it took for SPD staff to fill case carts dropped by an average of 10 min-
utes. The time it takes to restock items not used was also reduced.
Staff and physicians were happier with the new cards and process. “We had a de-
crease in turnover time, so we had satisfaction from physicians,” Very says.
She adds that when it comes to PC projects, “One of the most important things is
getting your staff engaged. It has to be a team effort.” ✥
Cynthia Saver, MS, RN, is president of CLS Development, Inc, Columbia, Maryland, which
provides editorial services to healthcare publications.
This is the format that staff at
UPMC Presbyterian Shadyside
Hospital developed.
Preference card comments:
Gloves:
Equipment:
Pharmacy:
Position:
Prep:
Drape:
Suture:
Drains:
Dressings:
Scrub:
• Open supplies:
• Available supplies
(hold until needed):
Circulator: (This section would
include special instructions, such
as type of postoperative bed to
request.)
Other:
Format for preference cards