title: Epidemiology and prevention of cast saw injuries: results of a quality improvement program at a single institution.
abstract: BACKGROUND
  An investigation was conducted to establish the hospital-wide prevalence of cast saw injuries and to identify variables that put patients at increased risk, with the goal of reducing the injury rate.
  
  
  METHODS
  Information was collected from January 2010 through December 2012 on all patients who had a cast removed or cut at our institution. Locations included the operating suites, emergency department, ambulatory clinics, and hospital floors. A cast cutting log was used to capture the total number of casts cut. An adverse event form was used to document each injury. A continuous quality improvement approach was used throughout the study period to implement incremental improvements to our program. Changes included an education and certification program on cast saw use for all providers, a protocol for a plastic surgery consultation, and a cast saw blade inspection protocol with maintenance logs.
  
  
  RESULTS
  Twenty-nine injuries occurred in 23,615 cast cuttings over the three years, for an overall rate of 1.23 (95% confidence interval [CI], 0.86 to 1.76) per 1000. A minor decrease in cast saw injuries was recorded over the course of the study (eleven of 8043 [1.37 per 1000] in 2010, ten of 7885 [1.27 per 1000] in 2011, and eight of 7687 [1.04 per 1000] in 2012), but the decrease was not significant (p = 0.87). The emergency department had the highest rate of cast saw injuries (p &lt; 0.0001), with a significantly greater rate during the night compared with the day (eleven of 1293 [8.51 per 1000] compared with fifteen of 19,419 [0.77 per 1000], respectively; p &lt; 0.0001). The injuries were all minor. Key risk factors for a cast saw injury included provider inexperience, patient sedation, and poor cast saw blade condition.
  
  
  CONCLUSIONS
  The rate of cast saw injuries in a busy pediatric orthopaedic department was small, but a considerably increased risk existed for those patients cared for in the emergency department by orthopaedic residents. Improving education and training in cast saw use has the potential to decrease the prevalence of cast saw injuries over time.
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Shore
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hutchinson
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: Marie
authors.initials: M
authors.lastname: Harris
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Bae
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Kalish
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: William
authors.initials: W
authors.lastname: Maxwell
authors.affiliation: Department of Orthopaedic Surgery (B.J.S., M.H., D.S.B., W.M., and P.W.), Main Operating Room (S.H.), and Clinical Research Center (L.A.K.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for P. Waters: Peter.Waters@chil.
authors.forename: Peter
authors.initials: P
authors.lastname: Waters
mesh_terms: D002370:Casts, Surgical / Q000009:adverse effects*; D002983:Clinical Competence; D004636:Emergency Service, Hospital; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D058996:Quality Improvement; D012307:Risk Factors; D013525:Surgical Instruments / Q000009:adverse effects*