Physician preference cards are intended to keep everything moving smoothly in surgery and improve quality of care, but too often they can complicate the process without adding any benefit. When that happens, the problem usually is that the preference cards have been allowed to proliferate with little or no oversight, one expert says.
The basic idea behind preference cards is sound, says Bill Denton, RN, MBA, chief operating officer with Novia Strategies, a consulting company in Poway, CA. He has led surgical departments in large, complex academic medical centers and often works with hospitals seeking to improve their operating room performance and processes. There is value to having surgeons operate with the particular supplies and methods that they find bring the best results for their patients, he says.
The problem is when the preference cards are changed so much that individual staff and the surgery system get bogged down, Denton says.
“Surgeons are used to getting what they want and they will sometimes put something on the card this week, and change it to something else next week. Physician preference cards should be like open enrollment for insurance, where you get a chance once a year to make changes to what you want,” Denton says. “Once a year might be too strict, but you could restrict changes to once a quarter or once a month and still streamline what goes on at most hospitals. If a doctor decides he doesn’t want to use this suture anymore and wants this one instead, they have to wait for the next chance to change the preference card.”
Physician preference card management should be overseen by a group of physician leaders, such as an executive committee, that may also be responsible for other professional issues that can affect the performance of the surgery department, Denton says. With many surgeons credentialed and each with preference cards for multiple procedures, it is not uncommon for hospitals to have tens of thousands of preference cards, he notes.
“A lot of times the responsibility for managing preferences is scattered across different nurses and managers, and sometimes it all falls on one person,” Denton says. “The workload increases every time a surgeon adds another card or changes even one thing on one card. Putting this in the hands of a physician executive committee will show them much impact that has.”
If a surgeon wants to change a preference card before the next designated time, he or she can take that request to the committee, Denton says. The surgeon’s peers can decide whether the reason for changing the preference card is significant enough to justify the exception.
Exceptions should be granted when the change would clearly benefit the patient, Denton says, such as when a new type of suture material is available or a supply item has been found to be defective.
Having a physician committee oversee preference cards will bring some accountability, Denton says. Physicians sometimes do not appreciate the administrative burden of preference cards and the importance of keeping them streamlined, Denton says. When required to review their own preference cards, surgeons often will realize they can’t remember why they once added an item or method to the card and wouldn’t mind having it removed in favor of standardization, he says.
Consider Cost of Supplies, Staff Time
Unnecessary specifications on preference cards can lead to substantial waste of supplies and staff time, Denton notes.
“The items are pulled for that doctor in every case because the preference card says so, and then they are either used when something less expensive would have satisfied the surgeon, and therefore wasted, or they are pulled and replaced at the end of the day. Someone has to spend time retrieving those items and replacing them, and when you’re talking about a hospital with a high volume of surgical procedures, that adds up quickly,” Denton says. “I’ve seen hospitals that employed the equivalent of two FTEs just to pull and replace items on preference cards.”
Denton suggests obtaining data from preference cards, usually easily obtainable from the electronic record, to compile a spreadsheet on what supplies are used by different surgeons for the same procedure. When there is substantial variability of the requested supplies and the resulting cost, the physician committee can go to surgeons and ask if they really need $10,000 worth of supplies for the procedure when most others are achieving the same results with $3,000 worth. Most surgeons will not want to be known for using dramatically more expensive supplies, Denton notes, and they may have no idea that their requested supplies cost so much.
“When you show surgeons what their colleagues are doing, it can be surprising to them. They may realize that this surgeon they know and respect is using a different product and it works just fine for a lot less,” Denton says. “Or they may both use six ounces of an anticoagulant, but one surgeon orders a six-ounce bottle and the other orders a 12-ounce bottle and throws away the rest because he didn’t know it even came in a six-ounce bottle.”
Administrators can be reluctant to challenge physicians on preference cards, expecting them to insist on whatever supplies they want in the name of good patient care, but Denton points out that doctors thrive on data and are naturally competitive. They also are attuned to how the economics of what they do can affect reimbursement and their careers.
“They don’t want to be an outlier when contracts are renegotiated and miss out on an opportunity because their procedures cost more to get the same results as everyone else. The good thing is that not only does reducing the variability and the constant changes lower the costs, but it also will make it more likely that the surgeons get exactly what they have requested, with fewer errors resulting from the sheer number of variables and updates that the staff has to manage,” Denton says. “You can tell the surgeons that if they will make sure they have on their preference cards only the things that really matter to them and not change it on a whim, we will guarantee that you will pull those items for you and you will always have what you requested.”
SOURCE
- Bill Denton, RN, MBA, Chief Operating Officer, Novia Strategies, Poway, CA. Telephone: (866) 747-4200. Email: [email protected].
