Introduction: Simulation-based training may improve overall healthcare value by improving outcomes and minimizing complications. However, there is limited information regarding the cost-effectiveness of simulation curricula, particularly in musculoskeletal conditions. The purpose of this study was to estimate the cost effectiveness of simulation training aimed at reducing cast saw injury by orthopaedic surgery residents. Methods: Beginning in January 2013, third-year orthopaedic residents rotating at a tertiary care children’s hospital were enrolled in a simulation-based curriculum, involving instruction on distal radius fracture reduction, cast application, and cast removal using an oscillating cast saw. Each group of residents completed two sessions in the simulation lab as part of this curriculum. For patients treated for distal radius fractures by orthopaedic residents in the Emergency Department, the incidence of cast saw injuries was analyzed before and after implementation of the simulation curriculum. Actual and potential costs associated with cast saw injuries–including wound care, need for clinical visits, as well as potential medicolegal payments–were obtained. Prior studies suggest that potential medicolegal costs of complications relating to closed treatment of distal radius fractures approach $100,000. The costs of cast saw injury were compared to the cost of the simulation curriculum to calculate overall savings and return on investment. Results: In the 2.5 years prior to simulation, cast saw injuries occurred at a rate of approximately 5.5 per 100 casts cut by orthopaedic residents. For the 2.5-year period post-simulation, the cast saw injury rate decreased to approximately 0.7 per 100 casts cut (p=0.0948). Actual costs attributed to cast saw injuries per resident rotation were approximately $65.83 before simulation, and negligible after simulation. Potential costs from medicolegal payments before and after simulation were estimated at $160,000 and $60,000 per rotation, respectively. The total cost to implement the casting simulation-based workshop was $2,465.31 per resident rotation. Total potential savings for the 2.5-year period post-simulation was $488,002.60, representing a 40 to 1 theoretical return on investment. Conclusions: The simulation-based curriculum on distal radius fracture reduction, casting, and cast removal for orthopaedic surgical residents was effective in reducing cast saw injuries and yielded a 40 to 1 return on investment. These results support the further development and investment in simulation-based training as cost-effective means of improving patient safety and clinical outcomes. 1 Halanski M, Noonan KJ: Cast and Splint Immobilization: Complications. Journal of the American Academy of Orthopaedic Surgeons 2008:16:30-40.

Figure 1

Absolute of cast saw injuries per resident rotation before and after initiation of simulation-based training program in January of 2013 (indicated by vertical line). As residents rotated every 6 months, each year was divided into a first half (A) and second half (B). Mean number of cast saw injuries per 6-month resident rotation before and after simulation indicated by dashed line.

Figure 1

Absolute of cast saw injuries per resident rotation before and after initiation of simulation-based training program in January of 2013 (indicated by vertical line). As residents rotated every 6 months, each year was divided into a first half (A) and second half (B). Mean number of cast saw injuries per 6-month resident rotation before and after simulation indicated by dashed line.

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