Tyler Gonzalez - Harvard Combined Orthopaedic Surgery Resident PGY ۳, Department of Orthopaedic Surgery, Massachusetts General Hospital, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA
Eric Bluman - Harvard Medical School, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA
David Palms - Harvard Medical School, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA
Jeremy Smith - Harvard Medical School, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA
Christopher Chiodo - Harvard Medical School, Brigham and Women’s Hospital Foot & Ankle Center, Boston, MA

 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 ۵۰۰, 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<۰.۰۰۱) 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 ۲ minutes ۵۲ 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.

Ambulatory surgery, Economics, Efficiency, Foot and ankle, lower extremity, Operating room, Splinting