Emergency department visits for work-related injuries

Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review

BACKGROUND

Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation.

METHODS

The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence.

RESULTS

Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature.

CONCLUSIONS

This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.

Examining associations between work-related injuries and all-cause healthcare use among middle-aged and older workers in Canada using CLSA data

INTRODUCTION

Prior studies examining the relationship between work- related injuries and healthcare use among middle-aged and older workers were mainly cross-sectional and reported inconsistent results.

OBJECTIVE

The objective of this study was to examine the associations between work-related injuries and 10 types of healthcare service use for any cause among middle-aged and older Canadian workers using longitudinal data.

METHODS

Our study involved longitudinal analysis of baseline and 18-month follow-up Maintaining Contact Questionnaire data from the Canadian Longitudinal Survey on Aging (CLSA) for a national sample of Canadian males and females aged 45-85 years who worked or were recently retired (N = 24,748).

RESULTS

Among CLSA participants who worked or were recently retired, 361 per 10,000 reported a work-related injury within the year prior to the survey. Work-related injuries decreased with increasing age. Work-related injury was associated with emergency department visits, overnight hospitalization, visits to dentists, and visits to physiotherapists, occupational therapists, or chiropractors at follow-up in bivariate analyses. Compared to those with no work-related injuries, Canadians with work-related injuries had used, on average, a significantly higher number of health services within the last 12 months prior their survey. When controlling for the contribution of various socio-demographic, work-related, and health-related characteristics, work-related injuries remained a significant predictor of emergency department visits and visits to physiotherapists, occupational therapists, or chiropractors.

CONCLUSIONS

The relationship between work-related injuries, emergency department visits, and visits to physiotherapists, occupational therapists, or chiropractors in middle-aged and older workers in Canada suggests that workplace injuries can be associated with ongoing health problems.

PRACTICAL APPLICATIONS

Healthcare services used by injured employees must be considered priorities for employment insurance coverage, if not already covered. Future research should more fully examine whether pre-existing health conditions predict both work-related injury and subsequent health problems. Injury-specific healthcare use following work-related injuries in middle-aged and older workers, as well as economic costs, should also be examined.

Economic costs and Predictors of occupation-related Injuries in Ethiopian sugar industries from the Employer’s perspective: top-down approach and friction method

Background

For many industrial workers, occupational injuries are a common health and safety concern. However, sufficient information on the economic costs and predictors of occupation-related injuries from the perspective of employers is lacking in developing countries, including Ethiopia. The objective of this study was to close this gap by quantifying the economic costs and predictors of occupation-related injuries in Ethiopian manufacturing industries from the employer’s perspective.

Methods

A cross-sectional study was employed to estimate the employer-side economic cost of occupation-related injuries from December 2021 to March 2022. This study used a top-down approach to compute direct costs, while the friction method was used for indirect cost estimation. Injury data were obtained from the Bureau of Labour and Social Affairs and the industries, while cost data were from workers’ compensation records. The insurance company’s injury compensation record was triangulated with industries’ data. The study collected primary data via an interview-administered, semi-structured questionnaire from 1136 randomly selected injured cases. Statistical analysis was carried out with STATA version 14 software. The study employed a generalized linear model to identify predictors of total cost by considering the non-normal distribution of the total cost. Exponentiate coefficients with a 95% confidence interval were used to express the direction and strength of the association.

Results

The survey participation rate was 100%. From the perspective of the employers, the total cost of occupation–related injury was 22,587,635.32 Ethiopian birr (537,800.84 $).Indirect and direct costs accounted for 65.86 and 34.14% of the overall expenses, respectively. Long-term absence from work (exp (b) = 0.85), having a sleeping disorder (exp (b) = 0.90), co-morbidity (exp (b) = 0.85), and severity (type) of injury (exp (b) = 1.11) were predictors significantly associated with the total cost variability in the fully adjusted model.

Conclusions

Employers’ toll of occupation-related injuries has severe economic implications. The influential factors that elevated the total cost variation were: long-term absence from work, unsafe acts of the workers, having a sleeping disorder, co-morbidity, and severity (type) of injury. Therefore, the identified modifiable factors are the areas of intervention to reduce the cost of occupation-related injuries.

Work-Related Injuries among Insured Construction Workers Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2016-2020)

Occupational injuries are one of the main causes of Emergency Department visits and represent a substantial source of disability or even death. However, the published studies and reports on construction-occupational accidents in Switzerland are limited. We aimed to investigate the epidemiology of fatal and non-fatal injuries among construction workers older than 16 years of age over a 5-year period. Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in construction accidents between 2016-2020. A total of 397 patients were enrolled. Compared to studies in other countries, we also showed that the upper extremity and falling from height is the most common injured body part and mechanism of injury. Furthermore, we were able to show that the most common age group representing was 26-35 years and the second common body part injured was the head, which is a difference from studies in other countries. Wound lacerations were the most common type of injury, followed by joint distortions. By stratifying according to the season, occupational injuries among construction workers were found to be significant higher during summer and autumn. As work-related injuries among construction workers are becoming more common, prevention strategies and safety instructions must be optimized.

Appropriate coding and billing in occupational health

ABSTRACT

Occupational health medicine plays a critical role in prevention, recognition, and treatment of injuries and illnesses of workers. This article explores commonly billed occupational injuries and illnesses.

Identification of work-related injury emergency department visits using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes

INTRODUCTION

Emergency department (ED) visit discharge data are a less explored population-based data source used to identify work-related injuries. When using discharge data, work-relatedness is often determined by the expected payer of workers' compensation (WC). In October 2015, healthcare discharge data coding systems transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). ICD-10-CM's structure offers potential new work-related codes to enhance work-related injury surveillance. This study identified work-related ED visits using relevant ICD-10-CM work-related injury codes. Cases identified using this method were compared with those identified using the WC expected payer approach.

METHODS

State ED visit discharge data (2016-2019) were analysed using the CDC's discharge data surveillance definition. Injuries were identified using a diagnosis code or an external cause-of-injury code in any field. Injuries were assessed by mechanism and expected payer. Literature searches and manual review of ICD-10-CM codes were conducted to identify possible work-related injury codes. Descriptive statistics were performed and assessed by expected payer.

RESULTS

WC was billed for 87 361 injury ED visits from 2016 to 2019. Falls were the most frequent injury mechanism. The 246 ICD-10-CM work-related codes identified 36% more work-related ED injury visits than using WC as the expected payer alone.

CONCLUSION

This study identified potential ICD-10-CM codes to expand occupational injury surveillance using discharge data beyond the traditional WC expected payer approach. Further studies are needed to validate the work-related injury codes and support the development of a work-related injury surveillance case definition.

Profile, risk factors and outcome of occupational injuries reported to the emergency department in a tertiary care hospital in South India

Background:

India is an industrialised country and most work is labour intensive. There is very scarce data on occupation related injuries

Aim:

To evaluate the prevalence, profile, severity and risk factors for occupational injuries presenting to the emergency medicine department of a tertiary care hospital.

Materials and Methods:

A cross-sectional study was done in the emergency department of Christian Medical College, Vellore among the patients who presented with occupational injuries. The risk factors for occupational injuries like age, gender, shift work, work experience and type of work and their severity and outcome were evaluated.

Results:

Older age group, working in shift duty, working longer hours were significant risk factors for occupational injuries.

Conclusion:

Training and use of safety protective measures will decrease occupational injuries.

Incidence of sharp and needle-stick injuries and mucocutaneous blood exposure among healthcare workers

Healthcare workers (HCWs) are exposed to biological hazards on a daily basis. The aim of the present study was to evaluate the risks of infection after occupational exposure to blood or body fluids among HCWs operating in the period 2013-2014, in a university hospital of Southern Italy. The frequency of accidents during the 2-year period was always lower than 5%. In 2013, 103 cases occurred; in 2014, the number of injuries had significantly decreased (n = 60). In 2013, an anti-hepatitis B surface antigen protective titer was only found in 70% of cases; in 2014, the subjects with a positive titer rose to 82%. No HCWs showed seroconversion to the main blood-borne pathogens. The implementation of strict prevention measures after the accidents reported in 2013 allowed the significant reduction of the number of injuries in 2014.