How to Fix and Manage Surgeon Preference Cards (Without Wasting Time or Money)

Overview

If you work in an operating room, you already know the reality: preference cards are outdated, supplies get wasted, items go missing during cases, and no one is quite sure who owns the process. Surgical facilities don’t set out to create bad preference cards — but as surgeon needs change without a clearly defined maintenance process, and the OR stays busy, cards slowly fill with bad information. This guide walks through three of the most common questions perioperative leaders ask the PREFcards team, with a practical, real-world approach to fixing the problem.

How Do You Clean Up Outdated Surgeon Preference Cards?

The exact approach varies by facility. A small ambulatory surgery center using paper cards will operate differently than a hospital running a modern EHR. That said, this process works for most environments.

Step 1: Start with High-Impact Cards

Don’t try to fix everything at once.

• Start with your most frequently used preference cards
• Or focus on high-cost procedures
• Or select the top 10–20 cards per service line

Break the work into manageable chunks and assign dedicated time for OR staff to focus on it.

Step 2: Review the Card with the Right Clinical Staff

Have the nurse or circulator most familiar with the procedure and surgeon:

• Identify incorrect or outdated items
• Suggest updates based on real experience
• Review critical notes and edit for accuracy and clarity

This ensures your changes reflect actual workflow — not assumptions.

Step 3: Rebuild the Card Using Real Supply Data

Have your team physically pick for the case:

• Supplies
• Medications
• Instruments

Then use product packaging information to improve accuracy:

• Manufacturer part numbers
• Exact product descriptions (change “large” to “28mL”)
• Correct sizes (e.g., “2-0 Vicryl CT 27 inch” instead of “Vicryl”)
• Storage location information

This step alone significantly improves picking accuracy and reduces errors.

Step 4: Track Actual Supply Usage Over Multiple Cases

For the next 3–5 cases (larger sample sizes are better, but decide what’s right for your needs), track:

• What was opened and used
• What was opened but not used
• What was missing

Use this data to adjust open/hold quantities, remove unnecessary items, and add missing supplies. This is where cards shift from “best guess” to data-driven accuracy.

Step 5: Validate with the Surgeon (If Possible)

Surgeon input is valuable, especially for preference-specific items and technique-driven differences. Even limited engagement can improve long-term accuracy and buy-in.

Fun fact: a general surgeon in the U.S. may perform a wide variety of surgeries, with one study indicating a mean of about 20 different procedure types annually — meaning roughly 20 unique preference cards for every general surgeon at your facility.

Step 6: Involve SPD and Supply Chain

Ask your Sterile Processing Department (SPD) and supply chain teams what information would make their job easier, and what fields are missing or unclear. Common improvements include standardized naming conventions, consistent item grouping, and clear inventory identifiers.

Step 7: Standardize Format and Naming

Consistency is critical for accuracy and speed.

• Use structured naming for sutures (Size – Type – Needle – Length)
• Avoid ALL CAPS, which reduces readability and slows recognition
• Include key identifiers like manufacturer part number and storage/bin location

Key insight: Facilities that succeed don’t try to fix everything at once. They focus on high-impact cards, use real case data, and build a repeatable process — leading to early wins, better staff communication, and long-term adoption.

How Do We Reduce Surgical Supply Waste from Preference Cards?

Reducing waste starts with visibility and data. A study of surgical waste at a single facility found an average of 11.5 items wasted per case.¹

Step 1: Tie Preference Cards to Real Inventory Data

At a minimum, your cards should include manufacturer part numbers, item descriptions, storage locations, and — if possible — item cost. This allows for accurate surgical case picking and meaningful analysis.

Step 2: Compare “Items Pulled” vs. “Items Used”

Set up a process to track supplies opened versus supplies actually used. This lets you adjust quantities, remove unnecessary items, and identify over-pulling behavior.

Step 3: Measure Waste Per Case

A simple but powerful KPI: supply waste per case equals the cost of opened-but-unused supplies. From there, track trends over time and compare before vs. after improvements.

Step 4: Scale the Impact

Once a card is optimized, multiply savings per case by annual case volume and set realistic cost-reduction goals. This is where leadership starts paying attention.

Step 5: Address Behavioral Habits

Even with good cards, staff may pull extra supplies or open items “just in case.” As trust in the cards improves, these behaviors naturally decrease.

Step 6: Use Available Tools (If You Have Them)

If your facility uses an EHR or software platform, run case cost reports and track trends over time. If not, use spreadsheets and compare against inventory usage and cost-of-goods trends.

Key insight: Waste isn’t just a supply chain problem — it’s a preference card accuracy problem. Fix the cards, and waste reduction will follow.

What Is the Best Process for Managing Preference Cards?

This is where most facilities struggle. A strong process includes clear ownership, a standard card layout, and consistent editing efforts with support from leaders.

Step 1: Establish Clear Ownership

Assign responsibility for preference card management — service line leads, experienced nurses, or specific owners per surgeon or procedure. Most importantly, give them protected time to do the work, and tie this responsibility to performance goals where possible.

Step 2: Create a Standard Card Format

Work with OR staff, SPD, and supply chain to define a format that’s clear, consistent, and easy to follow.

Step 3: Build a Feedback Loop

Create a process where issues from the OR are documented, feedback reaches card editors, and updates are made quickly. Without this, cards will always fall behind.

Step 4: Schedule Ongoing Maintenance Time

This is not a one-time project:

• Weekly: small updates
• Quarterly: targeted reviews
• Annually: full cleanup

Step 5: Clean Up and Consolidate Cards

At least once per year, remove cards for inactive surgeons, delete cards for procedures no longer performed, and consolidate duplicates. This helps reduce confusion and improve usability.

Step 6: Track Key Performance Indicators (KPIs)

Measure progress using:

• Supply waste per case
• Cost per case (by procedure)
• On-time case starts
• Items used vs. items pulled (goal: 85%+)
• Missing item rate (goal: under 5–10%)

Always establish a baseline and track trends over time.

Key insight: You can’t improve preference cards if you’re not measuring them.

Final Thoughts

Preference cards are not just documentation — they are a core part of how the OR functions. When they’re inaccurate, cases are delayed, supplies are wasted, and staff get frustrated. When they’re managed well, workflows improve, costs go down, and perioperative teams function with greater confidence. One recent project at UC San Diego School of Medicine reported savings of $3 million over five months by optimizing surgeon preference cards.²

The goal isn’t perfection — it’s continuous improvement backed by real data and clear ownership. It’s worth the effort to fix your preference cards, so start building your improvement plan today.

Footnotes

1. Bravo D, Thiel C, Bello R, Moses A, Paksima N, Melamed E. “What a Waste! The Impact of Unused Surgical Supplies in Hand Surgery and How We Can Improve.” Hand (N Y). 2023 Oct;18(7):1215-1221. https://pmc.ncbi.nlm.nih.gov/articles/PMC10798204/ ↩

2. UC San Diego School of Medicine preference card optimization project. https://jamanetwork.com/journals/jamasurgery/article-abstract/2841789 ↩