Systemwide Procedure Card Standardization to Reduce Surgical Supply Costs and Waste Without Detected Adverse Clinical Outcomes

General Information

Institution Name: Cleveland Clinic Foundation (18 participating health-system locations)

ACS Quality Program: SUSTAIN Collaborative

Year of Study: 2026

Author Name and Title: Benjamin T. Miller, MD; Associate Professor of Surgery

Name of Case Study: Systemwide Procedure Card Standardization to Reduce Surgical Supply Costs and Waste Without Detected Adverse Clinical Outcomes

Identification of Local Problem

Surgeon-specific preference cards varied substantially and could contain redundant, rarely used, or automatically opened supplies. This created unnecessary supply utilization, avoidable costs, and waste during laparoscopic cholecystectomy. The improvement objective was to standardize supply preparation, reduce documented supply costs and waste, and assess whether measured clinical outcomes changed.

Context of the QI Activity

A retrospective pre–post quality-improvement evaluation included 6,099 laparoscopic cholecystectomies (3,005 before and 3,094 after implementation) across an academic health system. The intervention covered 18 locations and 127 surgeons. Supply-chain, preference-card, operating-room documentation, and electronic health record data were used to assess supply utilization, costs, waste, and patient outcomes.

Interventions

A multidisciplinary team developed a standardized procedure card for laparoscopic cholecystectomy. The team removed duplicate and rarely used items, consolidated stock-keeping units (SKUs), reviewed actual supply-use patterns, and changed suitable supplies from default “open” to “open as needed” (PRN/hold). Surgeons retained discretion to request additional supplies based on clinical need.

Implementation Strategy

Health-system supply chain staff collaborated with surgeon-led and nurse-led preference-card committees to review existing cards and documented use. The standardized procedure card was applied across surgeon-specific cards at 18 sites, with subsequent refinements based on clinician feedback. Evaluation compared six-month periods before and after implementation, including documented supply costs, SKU variation, direct and indirect waste, and clinical safety measures.

Costs and Funding Sources 

The publication reports that the study received no funding or support. Implementation staffing and infrastructure costs were not separately quantified. Median documented supply cost per case per preference card decreased from $729.23 to $601.12 (17.6%; p=0.005). This is a comparison of documented costs, not a verified estimate of net financial savings after implementation expenses.

Overall Results and Analysis 

Among 6,099 cases, median documented supply cost per case per preference card decreased 17.6% ($729.23 to $601.12; p=0.005). Unique SKUs listed on preference cards declined 55% (984 to 438), while unique SKUs actually used intraoperatively declined only 2% (1,245 to 1,220). Indirect waste (supplies opened but not documented as used) decreased 27.3% per 1,000 cases (599.3 to 436.0), and its associated cost decreased 38.5% per 1,000 cases. Combined direct and indirect waste cost decreased 37.4% per 1,000 cases. Directly documented wasted items increased 15.4% per 1,000 cases, although direct waste cost decreased 23.1%. No statistically significant differences were detected in measured outcomes, including 30-day readmission (6.1% vs 6.2%), 30-day reoperation (0.9% vs 1.1%), ICU utilization, operative duration, length of stay, or short-term mortality. Carbon emissions were not measured.

Limitations

This project relied heavily on surgeon- and nurse-led teams to refine and consolidate procedure cards. These teams were organized and led by supply chain personnel. Hospitals or healthcare systems without broad supply chain support may have difficulty replicating these findings. 

Lessons Learned 

Standardization can simplify supply preparation while preserving surgeon flexibility and access to clinically needed items. Multidisciplinary governance, actual-use data, and “open as needed” defaults are practical and potentially replicable strategies. Assessing clinical outcomes of any quality improvement initiative is critical. As of November 2026, the procedure cards are still standardized. A recurring review cadence for the standardized procedure cards is under development. Future work should assess durability, broader procedure adoption, implementation costs, and direct environmental outcomes. 

Source

Alipouriani A, et al. Procedure card standardization and cost, waste, and clinical outcomes in laparoscopic cholecystectomy. Am J Surg. 2026;262:117262. doi:10.1016/j.amjsurg.2026.117262.