SIX PITFALLS OF OR PREFERENCE CARD MANAGEMENT AND HOW TO AVOID THEM

Transcription

1 SIX PITFALLS OF OR PREFERENCE CARD MANAGEMENT AND HOW TO AVOID THEM

2 SIX PITFALLS OF OR PREFERENCE CARD MANAGEMENT AND HOW TO AVOID THEM There are approximately 5,690 hospitals currently in the USA, which means that there are more than 5,500 groups of well-educated professionals struggling with the dilemma of how to keep the Operating Room (OR) preference cards accurate and current. However many resources are invested in the effort, the payoffs have been demonstrated time and time again: Decrease in delays Reduction in costs and wasted supplies Increase in physician satisfaction Decline in staff frustration Hopefully, the vast majority of those OR Departments have migrated to computerized scheduling and documentation systems that include automated preference cards for each surgeon and procedure. If electronic preference cards are integrated or interfaced with other pertinent information systems (Materials Management, SPD, and Biomedical), then the job of optimizing and maintaining the preference cards will be easier as long as the following six pitfalls are avoided: 1. Keeping unused procedures in the scheduling item master 2. Building preference cards for every procedure in a specialty for each surgeon 3. Allowing variation in the structure of the preference cards 4. Permitting changes to be made to the cards without a structured process 5. Leaving open and hold items on preference cards that are no longer used 6. Failing to establish and maintain a review calendar to systematically review all cards at least yearly How can we avoid these six pitfalls? Page 2

3 Keeping Unused Procedures in the Scheduling Item Master When OR scheduling systems are built, most organizations will load every possible surgical procedure into them and never look at the list again. Optimally, schedulers would only be able to see the procedures that each surgeon is credentialed to perform and is currently performing, but that is often not the case, and the array of possible procedures to choose can be confusing. Even if a slightly different procedure is chosen from the one being performed, it can map to a preference card that is not accurate. Best practice would be to use a nationally standardized nomenclature system that is integrated into the OR scheduling system and customize it for your specific organization. Reports can be structured to show the number of times and the last date a procedure was used. By deleting or inactivating procedures that have never been scheduled or have not been performed in the past five years, the list can be kept up to date and the correct procedure will be chosen more often. In addition, schedulers should receive ongoing education on how to interpret surgeon scheduling requests and choose the correct procedure, especially when complex procedures are booked. Whether the system was structured to merge multiple procedure cards for a case, or whether procedure names and preference cards were built in multiple combinations (e.g., D&C, Hysteroscopy and Endometrial Ablation; D&C with Endometrial Ablation; D&C and Hysteroscopy; Hysteroscopy and Endometrial Ablation), it can be difficult for schedulers with minimal OR training to select the best match. If schedulers understand how important their role is in selecting the correct procedure and how scheduling sets off a cascade of events that either lead to an effective process for gathering the equipment, instruments, and supplies for a surgical case or lead to a frustrating delay while everyone scrambles to set things right, they will make the effort to learn the best ways to schedule. Building Preference Cards for Every Procedure in a Specialty for Each Surgeon OR teams fear not having enough of anything, so they tend to build a card for every contingency. Again, reports can be built to identify preference cards not used in the past five years, or ever. In addition, surgeons are usually happy to tell you what procedures they will never perform, or will not be performing anymore, and those cards can be deactivated. The fewer preference cards there are to keep current, the higher the probability that they will be accurate. Page 3

4 Allowing Variation in the Structure of the Preference Cards Consolidation and standardization are the keys to accuracy, efficiency, and cost savings. If prep, draping, dressing, and commonly used procedural supplies can be standardized for different groups of procedures (e.g., laparoscopic, total joint replacements, or robotic cases), then generic procedure cards can be built for those groups of procedures. These are then copied and customized with gloves, sutures, and other surgeon-specific items. Standardization and consolidation of vendor choices for supplies leads to lower costs and makes the upkeep of preference cards more predictable. Having accurate supply descriptions and catalogue numbers on the pick lists is important as materials management staff are often unfamiliar with OR jargon: Give me a long bovie tip and more raytex. Sorting the supplies by location on the pick list will reduce time needed to assemble case carts, as this process is usually performed by people unfamiliar with the surgical procedure. Instrument trays may contain instruments that are never or seldom used, but are assembled and sterilized over and over just in case. Surgical procedures evolve as newer techniques, instrumentation, and technologies are introduced. Just as supplies must be evaluated and standardized on a regular basis, instrument sets must be subjected to a regular review process. Your organization may use Lean or Six Sigma teams for performance improvement. These small teams of people who are most knowledgeable about the process can be very effective in making recommendations to maximize the efficiency of the supply and instrument preparation for OR procedures. Lastly, the Comment section of the preference card should have a standardized format or template. The format ideally should follow the progression of the procedure and contain hints for the OR team for the following: Assembly of Equipment Medication and Solution Preparation Mayo Stand Setup Patient Positioning Prepping Draping Intraoperative Procedures Dressing or Casting Post-Operative Routines This will allow OR team members unfamiliar with a specific surgeon or procedure to quickly scan the steps to be taken in the order that they occur. Page 4

5 Permitting Changes to Be Made to the Cards without a Structured Process The most common pitfall of updating preference cards is to take a change requested by an OR team member and make it on the card for the surgeon-specific procedure that prompted the request. ( Today the surgeon yelled at me because I didn t have a 2-0 Vicryl on a CT-1 needle, so put it on the card! ) Stop and ask the following questions: Was this a one-time request because the patient/incision was larger/smaller than average, or has this surgeon decided to change his suture from 3-0 to 2-0 on all of his laparoscopic/total joint/herniorrhaphy procedures? Is this suture replacing something, or is it an additional one? While we are addressing this suture, is this surgeon s suture routine accurately reflected on the preference cards for this group of procedures? Making sure the cards for ALL herniorrhaphies are correct will prevent the refrain often heard in the OR: Well I changed the suture, but the old one keeps popping up on the preference card! There must be something wrong with the system, so what s the use of making changes? To make sure that the surgeon or team members who are very familiar with his/her routines and preferences have input on keeping the cards updated, a formal procedure for making changes should be implemented. Changes can be requested by the RN or CST as they occur either on a separate request form or on the case-specific preference card. A limited number of people with access to make changes will keep the process more accurate and agile. Some OR departments designate the Clinical Specialty Managers to make changes, although this may slow down the process as they are often very busy people. An OR Systems Administrator or Analyst may be the designated change agent, with a mandate to obtain a Specialty Manager s approval before making the changes. Best practice is to make the change in time to have the correct items available the next time the surgeon performs that procedure. Page 5

6 Leaving Open and Hold Items on Preference Cards That Are No Longer Used Hold items often get onto preference cards because the surgeon asked for them once and wasn t amused when the circulator had to leave the room to get it. These hapless items get put on case carts and back on the shelf over and over, wasting time and money. Sometimes they get opened and wasted because someone was in a hurry and didn t look at the card. If a surgeon stops using an item, the information may not be passed on to get it off the preference card. Once again, reports of how often an item is used for a procedure can serve as a guide for questioning whether it should be on the preference card in the first place. Failing to Establish and Maintain a Review Calendar to Systematically Review All Cards at Least on a Yearly Basis The designated Administrator or Analyst can set up a calendar to review procedures and preference cards that are no longer in use, whether groups of procedures are still standardized, the accuracy of each specialty s cards, and items that are not currently used but are still on cards. Depending on the size of the OR suite and resources available, time can be set aside to review each group every year or six months. Once preference cards are updated on a consistent and ongoing basis, additional performance improvement projects can be initiated based on more accurate information gleaned from the OR information system. Procedure costing and value analysis of procedures that are supply- or technology-intensive can be useful budgetary tools. Surgeons may be presented with cost analyses of their procedures, and more costconscious surgeons are able to share information that leads to more standardization and buy-in from other surgeons. Next Steps Establishing an effective preference card system is crucial in obtaining smooth OR functions, and regularly maintaining and updating the system is just an important. If your organization could benefit from implementing better preference card practices, or if you need assistance pinpointing breakdowns in your current preference card system, Soyring Consulting can help. Reach out to our team to learn how we can improve operations and ultimately improve outcomes. Contact us today or call us at Page 6

7 About Soyring Consulting Soyring Consulting provides clinical and managerial consulting services to healthcare facilities of all sizes, including For-profit, Not-for-profit, Community, University, and Faithbased facilities and systems. Our team has worked in more than 35 states across the United States in all areas, including surgical services, sterile processing, hospital and facility design, nursing/clinical units, and others. By combining our experience, proven knowledge, and time-tested skills, we work with your team to create targeted opportunities, along with the plan and achievable goals to reach them. For more information, visit or call our corporate office at (727) to speak with a representative of our leadership team st Ave. N. / St. Petersburg, FL Website / Phone / Page 7