Surgical Preference Cards


OR Link. It pays to think differently.

Stand out from the crowd

What a great concept!  When is it good to stand out and when is it best to be like everybody else?  Surely we can all think of examples of when the importance of each is underscored.  The military comes to mind.  It would seem to me that members of a military regiment must be aligned in an approach to achieve a common goal.  Whatever your stance is on the role of the military in foreign or domestic theaters, it strikes me that a common vision is of vital importance.  Individuality, however, has its own merits!  Where would we be without people who lead by example?  As a surgeon with nearly 15 years’ experience, it has been a source of great pride for me to learn that others had adapted their way of doing a procedure because he/she liked the way I did something.

We surgeons, approach our craft with the same level of scrutiny and introspection as any professional.  I used to love watching film of other surgeons operating.  Simple or complex, it didn’t matter.  There was always something to learn from someone else’s work.  That also includes a review of pertinent literature.  The field is constantly changing and surgeons appropriately adapt as data emerges to guide behavior.

A recent article from Kathleen Simon in the American Journal of Surgery found something quite interesting.  Surgeons at their academic institution looked at a cost de-identified series of items to complete a laparoscopic cholecystectomy.  Seventeen different surgeons reviewed the list and chose a single set of picklist items to use for their procedures.  After six months of scrutiny without using the conformed picklist items, surgeons then had the option to switch to the unified laparoscopic cholecystectomy picklist.  The surgeons used these unified items for an additional six months.  Shockingly, the mean cost of disposable supplies dropped by 32%!   They also noted two additional remarkable things, in my opinion.  Each surgeon who was notified of a costly item and a more economical option opted for the latter.  Also, they found a large number of surgeons who had items on their picklist that were rarely used.  The amount of waste present in operating rooms is nothing new.  Zygorakis et al. estimated an annualized waste of nearly 3 million dollars in a single service line!

These studies corroborate two core messages here at OR Link.  We have very little ownership collectively over the data behind our patient’s procedures. Surgeons don’t know the cost of their supplies and therefore can’t make informed, independent, decisions about what articles to use.  When presented with the information, surgeons usually make an economic decision that’s right for the hospital and right for the patient.   Secondly, surgical picklists/preference cards are inherently inaccurate further complicating case cost and driving frustration for all parties involved.  So like in anything else, there appears to be a balance here of conformity and individuality.  Surgeons will independently elect to conform to the logical and more economical choice of items when provided the data to do so.  Expressing individuality by choosing something that puts you in the crowd.  A paradox?  We think it makes perfect sense.

Can you imagine having an accurate, data-driven, preference card that aligns the procedural needs of a surgeon with the economic needs of the hospital?  Can you imagine an operating room that is filled with a team focused on a common goal, the well-being of the patient, rather than the frustration of unmet needs and untimely interruptions in the flow of surgery?  We can.  We have.

Jason Harris, MD CMO CEO

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