Informatic Innovations to Surgical Preference Card Processes

Each year over 234 million surgeries are performed globally, with approximately 3-16% of patients experiencing major complications. The structure of the operating room (O.R.) team is comprised of interprofessional members with various levels of education, experience, and specialties. Unfortunately, care coordination and collaboration issues among providers can lead to breakdowns in communication, collaboration, and patient harm. Preference cards are detailed instructions with items, instruments, implants, nursing notes, and special requests for each surgeon for every procedure they conduct. In the OR, preference cards are a utilized tool to communicate required items, nursing notes, and special comments to the team to provide safe, high-quality care to patients. Preference cards are built and housed via cloud technology into the electronic health record (EHR) to allow easy access, shared storage, and linkage to the patients chart for documentation and billing purposes.

Inaccurate preference cards can lead to inefficient use of staff time, surgical delays, increased turnover times, increased safety risks, excess waste and costs, poor team dynamics and collaboration, hindered communication, and dissatisfaction among staff. It is common in the perioperative world that staff recieve negative feedback from a surgeon regarding preference card updates that do not get completed with cards that he or she have already asked for in the past – once, twice, or even three times or more. A level of frustration typically revolves around surgeon preference cards for the surgeon, assistants, nurses, and scrub technicians alike due to communication breakdowns with the preference cards. But who does the responsibility of surgical preference cards ultimately lie with? The OR suite is a fast-paced, stressful, and stimulating environment that pulls the staffs attention in a multitude of directions and the team should not have to worry about if the information they have is inaccurate or not up to date.

To improve coordination and collaboration in the perioperative environment, a three-tiered approach to addressing surgical preference card issues and process improvements (PI) is explored. Tier one of the PI project is the creation or bolstering of surgical service leads that have autonomy for their service’s preference cards. Tier two involves the on-boarding of new surgeons to the facility with the surgical services nursing informatics team, sterile processing department (SPD) leads, and their service lead for preference card creation. Tier three includes three parts: electronic health record (EHR) preference card inbox tool and utilization implementation, a preference card working group, and quarterly reviews of preference cards with surgical services NIs, service leads, and surgeons for accuracy and updates. The three-tiered intervention utilizes nursing informatics expertise and technology adjuncts in the EHR to improve processes, bolster collaboration among interdisciplinary members, enhance communication, and improve team dynamics. This PI project relied on evidence-based practice (EBP), nursing and analytic theories, and literature reviews to help structure the PI project. The methodology utilized in this project for research gathering included questionnaires to circulating nurses and scrub technician and interviews of stakeholders outside of the OR nursing team – surgeons, leadership, administration members, SPD leads, logistic officers, managers, and the nursing director of surgical services. The analysis of the data and needs assessment demonstrated the need for PI of preference card creation and management. The three-tiered intervention approach was developed and presented to the hospital review committee for approval at four organizational OR hospital affiliates in December 2024. The learning outcome identified is understanding how to leverage technology to streamline OR processes, decrease waste and unnecessary costs, improve collaboration/teamwork, improve safety, and facilitate high-quality surgical patient outcomes.