Surgeon Preference Cards: Common Questions, Answered by Real OR Experience

Overview

Surgeon preference cards are one of the most important — and most frustrating — tools in the operating room. If you’re an OR nurse, surgical tech, or perioperative leader, you’ve probably dealt with cards that are outdated, missing supplies during cases, too many unnecessary items, and no clear process for fixing anything. This guide answers the most common, real-world questions people ask about preference cards, and explains what’s actually going on behind the scenes.

What Is a Surgeon Preference Card?

A surgeon preference card is more than just a list of supplies. A well-built card clearly outlines everything needed for a specific procedure performed by a specific surgeon, including:

• Supplies and medications that should be opened and ready
• Instruments and trays
• Equipment required in the room
• Notes on patient positioning, prep, and draping
• Room setup or layout preferences

At its best, a preference card helps the OR team prepare consistently, safely, and efficiently for every case.

Where Do I Find the Preference Card for a Case?

Preference cards are usually stored in a central location accessible to the OR team. Depending on the facility, this could be a paper binder, a shared drive with Word or Excel documents, or a module inside the EHR. If you’re unsure where to find them, your charge nurse, OR manager, or circulating nurse should be able to point you in the right direction.

Why Are Preference Cards Often Wrong or Outdated?

This is one of the most common frustrations in the OR. The main reason preference cards don’t stay accurate is that updating them usually requires a manual step, and that step often gets missed. Common causes include:

• No clear ownership of who is responsible for updates
• No dedicated time to document changes after cases
• Systems — paper or digital — that are slow or difficult to update
• No feedback loop to capture what happened during the case

Over time, these small gaps add up, and cards slowly become unreliable. In one recent survey, 46% of surgeons said they rarely or never updated their preference cards.¹

How Do I Update or Fix a Preference Card?

Most facilities have a process, but it isn’t always clear or consistent. In many cases, a service line charge nurse (e.g., orthopedics) owns the cards, or experienced nurses are assigned to specific surgeons. If you notice an issue:

• Take note of what was wrong or missing
• Share that information with the person responsible for that card
• Confirm whether the change is permanent or specific to that case

The key is making sure updates are intentional and verified, not just one-off requests.

Why Are There So Many Items on This Card That We Don’t Use?

This is extremely common, and it usually happens over time. Preference cards tend to grow because staff add items “just in case,” items are rarely removed, and there’s no regular editing or review. Many operating rooms see up to 40% of picked supplies — gloves, drapes, and sutures — go unused for a case due to inaccurate preference cards. This leads to wasted supplies, longer picking times, and more work for OR and supply chain teams.

What Should I Do When Something Is Missing During a Case?

In the moment, the priority is simple: get the needed item into the room as quickly as possible, usually by calling for help from staff outside the OR. But what happens after the case matters just as much. Ask the surgeon whether the item was missing from the preference card, and whether it was a one-time situation or something that should be added permanently. Taking a minute to follow up helps prevent the same issue from happening again.

Why Do Surgeons Prefer Different Items for the Same Procedure?

Even when surgeons perform the same procedure, their preferences can vary quite a bit. This usually comes down to differences in training and mentorship, personal habits and comfort level, experience with certain products or techniques, and exposure to new tools or vendor recommendations. Surgery isn’t completely standardized, and preference cards reflect that reality.

How Detailed Should a Preference Card Be?

At a minimum, a good preference card should include all commonly used supplies and medications, instruments and trays, and equipment needed for the case. It should also include basic guidance on patient positioning, room setup, and preparation steps.

A great preference card goes a step further. It’s clear and easy to read, built with supplies and equipment that are truly being used — not assumptions — and detailed enough to prepare consistently without being overwhelming.

Why Does It Take So Long to Pick Supplies for Cases?

Slow picking is often a symptom of poor preference card structure. Common issues include disorganized or hard-to-read layouts, missing or unclear information, and too many unnecessary items. Improving the structure of a preference card so it’s clean, organized, and accurate can significantly reduce the time and effort needed to prepare for a case.

Why This Matters More Than People Think

Preference cards aren’t just documentation — they directly impact how the OR runs. When cards are inaccurate or poorly maintained, it can lead to delays during cases, increased supply waste, frustration for nurses and techs, and lower surgeon satisfaction. Well-managed preference cards, on the other hand, help create a smoother, more efficient workflow for everyone involved.

Quick Answers

What is a surgeon preference card? A detailed list of supplies, instruments, and setup instructions needed for a specific procedure by a specific surgeon.

Why are preference cards often inaccurate? They rely on manual updates, and without clear ownership or processes, those updates are often missed.

Who is responsible for updating preference cards? This varies by facility, but it’s often assigned to a charge nurse, service line lead, or experienced clinical staff.

How can preference cards be improved? By keeping them accurate, removing unnecessary items, and updating them regularly based on what’s actually used during cases.

How are other nurses picking cases when our cards are incorrect? Many nurses and surgical techs keep personal notes — often on their phone — for “their” surgeons and common cases, as a workaround for bad cards. It works in the moment, but it masks the underlying problems with the preference cards themselves.

Final Thoughts

Most hospitals don’t have “bad” preference cards — they have good-enough cards that slowly become unreliable over time. The real challenge isn’t creating preference cards; it’s maintaining them in a way that keeps up with real-world surgical practice. Even small improvements — clearer ownership, better communication, and more consistent updates — can make a noticeable difference in day-to-day operations.

Footnotes

1. Palmisano ZM, Sullivan GA, Petit HJ, Gulack BC, Myers J, Shah AN. “Surgeon perspectives on preference cards and environmental stewardship.” World J Surg. 2024 Sep;48(9):2165-2173. https://pubmed.ncbi.nlm.nih.gov/39107916/ ↩