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Surgical site infections (SSIs) remain a significant challenge in modern healthcare, contributing to increased morbidity, prolonged hospital stays, and higher costs of care. While extensive efforts have been made to mitigate the risk of SSIs through improved sterility protocols, antimicrobial prophylaxis, and patient risk stratification, operating room (OR) efficiency remains an often-overlooked factor.
Data-driven supply intelligence that informs optimization of the surgeon preference card—a mission critical, yet frequently outdated, inaccurate component of surgical workflows—has the potential to reduce unnecessary OR traffic, enhance efficiency, and ultimately lower the risk of SSIs.
The Link Between OR Efficiency and SSIs
Studies have shown that unnecessary movement in and out of the OR correlates with increased airborne bacterial contamination. A recent study highlighted that increased door openings significantly raised colony-forming unit (CFU) counts in the OR, particularly outside of laminar flow conditions (Perez et al., 2018). In orthopedic procedures, where implants and hardware are involved, this increase in environmental contamination is particularly concerning as it could lead to surgical site, instrument, or implant contamination.
Furthermore, a quality improvement project aimed at reducing OR traffic demonstrated a nearly 50% reduction in door openings per minute, which corresponded with a dramatic drop in the standardized infection ratio (SIR) from 1.75 to 0 over a 10-week period (Parent, 2021). Key interventions included stricter door policies, batching of staff breaks, and, most importantly, preference card reviews to ensure that the necessary surgical instruments and supplies were in the OR before the incision.
Finally, OR supply inefficiency can generate operative case delays that extend surgical time. There is ample data correlating longer surgical time with increased risk of SSI. So, if a surgeon is delayed intraoperatively while awaiting a missing supply, instrument or implant, patient risk can increase.
Preference Card Optimization: An Overlooked Opportunity for Physician Engagement
When it comes to surgeon preference cards, despite their critical role in surgical efficiency, they are often outdated, incomplete, or overly redundant. Bottom line - they are often inaccurate. Why is that while a chef knows exactly what ingredients they will have in their kitchen, surgeons enter their OR's every day unsure of whether the supplies they need will be present in the quantities they need, or present at all? When essential supplies are missing from the OR setup, circulators must leave the sterile field to retrieve items, increasing foot traffic and door openings. Conversely, overstocking the OR with unnecessary instruments leads to inefficiencies, higher costs, and a costly burden on sterile processing departments.
In spite of broad recognition of the importance of preference card data, maintaining accurate and up-to-date preference cards is a complex task that requires consistent input and engagement from surgeons, perioperative nurses, and supply chain teams.
How a Digital Platform Like DOCSI Can Help
Traditional preference card management relies on static documentation and periodic manual reviews, which are time-consuming and prone to inaccuracies. A dynamic digital platform like DOCSI revolutionizes this process by providing real-time analytics, utilization tracking, and collaborative editing tools that enable continuous refinement of preference cards based on actual case needs.
By integrating with existing OR workflows, DOCSI can help hospitals:
Reduce OR traffic by ensuring all necessary supplies are in place before surgery begins.
Minimize waste by identifying redundant or rarely used instruments and supplies.
Enhance surgeon engagement through intuitive dashboards that allow real-time feedback on what works and what doesn't.
Ensure card updates are being implemented by enhancing the workflows of perioperative nursing staff that are responsible for maintaining cards.
Standardize best practices across surgical teams by leveraging data-driven insights into efficiency and supply usage, reducing variation, and increasing efficiency.
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References
Parent, M. (2021). OR traffic and surgical site infections: A quality improvement project. AORN Journal, 113(4), 379-387. https://doi.org/10.1002/aorn.13355
Perez, P., Holloway, J., Ehrenfeld, L., Cohen, S., Cunningham, L., Miley, G. B., & Hollenbeck, B. L. (2018). Door openings in the operating room are associated with increased environmental contamination. American Journal of Infection Control, 46(9), 954-956. https://doi.org/10.1016/j.ajic.2018.03.005
Dr. McCarty is a practicing orthopedic surgeon in Minneapolis, MN, former team physician for the Minnesota Twins, Fuqua alum, healthcare leader, and entrepreneur.