The Art of the Preference Card

Keeping surgeon-specific cards accurate and up to date (without losing your mind).

Preference cards are the OR’s cheat codes. When they’re clean and current, your setup flows, your counts are tight, and your turnover doesn’t feel like a sprint. When they’re messy… hello delays, hunting, and waste. Here’s a simple, no-nonsense guide to make your cards rock.

What a good card does (in plain terms)

• Tells you what to open, what to stage, and when it matters.
  
• Uses plain names (generic + brand) and exact sizes.
  
• Lives in one home (EHR or shared drive) with clear ownership and version.
  
• Fits the actual way the surgeon works today—not five cases ago.
  
  

Build a clean, predictable layout

Keep the order the same across all surgeons so new staff don’t relearn every time.

Header (at the top):

• Surgeon • Procedure/Approach • Side/Level • Position • Room needs (bed, attachments)
  
• Imaging plan (none/C-arm/O-arm; when to shoot)
  
• Antibiotic & timing window
  
• Special reps to call (name/phone)
  
  

Sections (in this order):

1. Prep & Drapes – skin prep, drape style, extras (Ioban, leggings, bump).
   
2. Positioning – table, pads, arm boards, tourniquet settings, traction, pearls (“pad ulnar nerve”).
   
3. Equipment – power, towers, lights, smoke evac, video, insufflator settings.
   
4. Trays & Instruments – list by tray name, then key singles (with sizes).
   
5. Sutures/Staples – by step (“closure: 2-0 Vicryl x2; skin: 4-0 Monocryl”).
   
6. Implants – system, sizes to stock/trial, rep notes.
   
7. Meds on the field – local mix, irrigation, hemostatics (doses/route).
   
8. Disposables – blades, tips, dressings, specimen cups, labels.
   
9. Workflow notes – “x-ray after trialing,” “pause for implant read-back,” “send synovium fresh.”
   
10. Counts/Specimens – any special count rules; specimen labeling phrases to use.
    
11. Quirks (yes, call it that) – “likes 10 blade only,” “no chlorhex on face,” “double glove for stapling.”
    
    

Tip: Keep sentences short. One item per line. If you need a paragraph, you probably need a workflow note instead.

Naming, wording, and sizing (your consistency rules)

• Use generic name + brand: “suction tip, Poole (Medline)” instead of “Poole tip” only.
  
• Always include sizes: “S retractor 20 mm” beats “S retractor.”
  
• Standard shorthand is fine—but ban mystery abbreviations that new hires won’t decode.
  
• Avoid “open if needed.” Say when: “Open vascular set if EBL > 300 mL.”
  
  

Versioning that actually sticks

Put a tiny “ID box” on every card:

• Owner: (name/role)
  
• Version & date: v1.7 — 2025-08-01
  
• Last verified by: (surgeon or designee)
  
• Change log: one-line bullets (“Added 36 mm trial; moved fluoro to after trialing.”)
  
  

Only one master lives in the EHR/shared drive. If you print, stamp “Print date: ____” so stale copies are obvious.

How to capture the real workflow (fast)

Use a tight, repeatable play:

1. 5-minute huddle with the surgeon (or PA): “Top 3 must-haves? Top 3 nice-to-haves? Any never-use items?”
   
2. Observe one case and mark every “pause” or “ask.” Those become workflow notes.
   
3. Scrub tech reality check: “What’s missing? What do we always fetch mid-case?”
   
4. Rep sanity pass for implant trays and sizes.
   
5. Pilot the card for 3 cases. Fix small stuff same day.
   
   

Keep it fresh without a big project

• Golden minute: After each case, jot quick edits on a mini “card fix” slip. Update the master by end of day.
  
• Monthly micro-audit: Pick 5 high-volume procedures and delete zombie items.
  
• New hire pass: Ask a novice to set up using the card only. Wherever they stumble, tighten wording.
  
• Sunset rule: If an item wasn’t used in the last 10 cases, move it to “on-hand only” or drop it (confirm with the surgeon).
  
  

Read-backs you should hardwire into the card

• Implant system, size, side/level → “Read-back before opening.”
  
• Imaging moments → “Call for fluoro after trialing, before final.”
  
• Specimens → “Say label out loud: ‘patient, site, specimen type.’”
  
• Counts → “Sponge/raytec/misc count before drapes off.”
  
  

Make it easy to find (and filter)

• File name: Lastname_Firstname – Procedure – Approach/Side – vX.Y (YYYY-MM-DD)
  
• Tag fields inside the card: specialty (ortho, neuro), equipment (C-arm), rep (company).
  
• Add a QR code on the room board or case schedule that opens the card on mobile/EHR.
  
  

Metrics that tell you cards are working

Track these for a month and watch the change after your cleanup:

• First-case delays due to setup (aim: ↓)
  
• Mid-case “go get it” trips (aim: ↓)
  
• Unused opened items (aim: ↓)
  
• Time-to-ready from wheels in (aim: ↓)
  
• “Card defects” reported per 10 cases (aim: ↓)
  
  

Tiny habits = big wins

• Update now, not “later.”
  
• Put sizes everywhere.
  
• Write when to open (triggers), not “maybe.”
  
• Keep quirks visible—saves everyone’s sanity.
  
• Close the loop with a one-line change log.
  
  

Common pitfalls (and easy fixes)

• “Open if needed” everywhere → Replace with a trigger (“if EBL > 300 mL, open vascular set”).
  
• Brand-only names → Add generic and size.
  
• Huge paragraphs → Convert to checkable lines.
  
• Multiple masters → Pick one source of truth; mark printouts with date.
  
• No owner → Assign a name. If everyone owns it, no one owns it.
  
  

Bottom line

Great cards are living documents. Keep them short, specific, and owned. Update a little every day, build in read-backs, and make quirks obvious. Do that, and your setup gets faster, your waste drops, and your team feels one step ahead—every case, every time. 💪🩺