Reducing cast-saw injuries through simple simulation

During cast removal, a cast-saw burn is an adverse event that causes the patient harm and can result in an additional cost to all stakeholders in the form of additional medical care, hospital visits and malpractice payments. Orthopedic surgeon Donald Bae, MD and colleagues examine the clinical efficacy and cost-effectiveness of simulation training designed to reduce cast-saw injuries in-clinic.

With the help of a small seed grant from the Program for Patient Safety and Quality, the team created a novel tool that measured temperatures at the surface of a model used for casting practice. Through establishing the temperatures associated with pain, as well as burns, the model was used to teach residents how to remove casts without injuring the patient.

When comparing cast-saw injury rates at our institution before and following this simulation, a significant reduction in injury rates was found during a 2.5-year period after simulation. Along with improving patient care, this decrease in cast-saw burns also produced a theoretical return on investment of 11 to 1.

Bae DS, Lynch H, Jamieson K, Yu-Moe CW, Roussin C. Improved Safety and Cost Savings from Reductions in Cast-Saw Burns After Simulation-Based Education for Orthopaedic Surgery Residents. J Bone Joint Surg Am. 2017 Sep 6;99(17):e94.