Costs of an operation are significant, and many of the costs incurred in the operating room are due to using expensive equipment, materials, sutures, and supplies. Each attending surgeon has an OR "preference list" for each specific case that they perform, which is a list of all of the supplies, equipment, and materials they need for that case. This list directs the operating room staff (OR scrub technician and OR nurse) in terms of what materials and supplies they need to gather and open for use in the operating room.

The OR preference lists are not kept up-to-date. Often, these lists are the result of a preference list that was made literally years ago, and even though the attenending surgeon has made changes to the way they do the operation or the materials they use, the preference list is not updated and thus unnecessary supplies are opened and unused. Once a supply is opened it must be charged, and there are often many supplies that are opened unnecessarily and are never used (and were never going to be used). This happens particularly if there is a scrub tech or OR nurse who does not do the attending's case routinely and therefore does not know to avoid opening items on the list which will not be used during the case. The costs of opening these unused items is significant - not only the supply costs which are often quite large, but OR time is expensive as well, and every minute wasted on retrieving and opening materials that will not be utilized adds up to a significant expense for the medical center.

At UCSF Health System (both Parnassus and Mount Zion), I propose that we develop a system to have preference lists reviewed and updated by the attending surgeon on a regular (q3 month) schedule. This will ensure that unnecessary items are eliminated and necessary items are included, saving costs related to both unused supplies and OR time.