Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

Document Type : RESEARCH PAPER

Authors

1 Harvard Combined Orthopaedic Surgery Resident PGY 3, Department of Orthopaedic Surgery, Massachusetts General Hospital, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA

2 Harvard Medical School, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA

Abstract

 Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application.

Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed.

Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group.

Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety.

Keywords

References

  1. Friedman DM, Sokal SM, Chang Y, Berger DL. Increasing Operating Room Efficiency Through Parallel Processing. Ann Surg. 2006; 243(1):10–4.
  2. Overdyk FJ, Harvey SC, Fishman RL, Shippey F. Successful strategies for improving operating room efficiency at academic institutions. Anesth Analg. 1998; 86(4):896–906.
  3. Saleh KJ, Novicoff WM, Rion D, MacCracken LH, Siegrist R. Operating-room Throughput: Strategies for Improvement. J Bone Joint Surg Am. 2009; 91(8):2028–39.
  4. Seim AR, Dahl DM, Sandberg WS. Small changes in operative time can yield discrete increases in operating room throughput. J Endourol. 2007; 21(7):703–8.
  5. Ernst C, Szczesny A, Soderstrom N, Siegmund F, Schleppers A. Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: evidence from German hospitals. Anesth Analg. 2012; 115(3):671–7.
  6. Cima RR, Brown MJ, Hebl JR, Moore R, Rogers JC, Kollengode A, et al. Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg. 2011; 213(1):83–92.
  7. Short leg splint application. Available at: http://www.orthopaedicsone.com/display/Main/Short+Leg+Splint+Application.
  8. Hedges L, Olkin I. Statistical Methods for Meta-Analysis. In: Statistical Methods for Meta-Analysis. California: Academic Press; 1985.
  9. Sokal SM, Chang Y, Craft DL, Sandberg WS, Dunn PF, Berger DL. Surgeon profiling: a key to optimum operating room use. Arch Surg. 2007; 142(4):365–70.
  10. Weinbroum AA, Ekstein P, Ezri T. Efficiency of the operating room suite. Am J Surg. 2003; 185(3):244–50.
  11. Krupka DC, Sandberg WS. Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol. 2006; 19(2):185–91.
  12. Harders M, Malangoni MA, Weight S, Sidhu T. Improving operating room efficiency through process redesign. Surgery. 2006; 140(4):509–14.
  13. Bailey D. Automotive News calls Toyota world No 1 car maker. Reuters: Reuters com; 2008.
  14. Ohno T, Bodek N. Toyota Production System: Beyond Large-Scale Production. Kindle ed. Portland: Oregon; 1988.
  15. Ruffa SA. Going Lean: How the Best Companies Apply Lean Manufacturing Principles to Shatter Uncertainty, Drive Innovation, and Maximize Profits. American: Besiness & Econimics; 2008.
  16. Antony J. Some pros and cons of Six Sigma: an academic perspective. TQM Magezine. 2008. 16(4):303-6.
  17. Collar RM, Shuman AG, Feiner S, McGongal AK, Heidel N, Duck M, et al. Lean management in academic surgery. J Am Coll Surg. 2012; 214(6):928–36.
  18. Smith MP, Sandberg WS, Foss J, Massoli K, Kanda M, Barsoum W, et al. High-throughput operating room system for joint arthroplasties durably outperforms routine processes. Anesthesiology. 2008; 109(1):25–35.

 

The Archives of Bone and Joint Surgery
Volume 4, Issue 1 - Serial Number 1
January 2016
Pages 10-15

Files

History

  • Receive Date: 18 March 2015
  • Revise Date: 21 May 2015
  • Accept Date: 23 May 2015

Share

How to cite

Statistics