Evaluation of direct workers' compensation costs for musculoskeletal injuries surrounding interventions to reduce patient lifting.

Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Occupational and environmental medicine (Impact Factor: 3.23). 12/2011; 69(5):367-72. DOI: 10.1136/oemed-2011-100107
Source: PubMed

ABSTRACT We evaluated costs for workers' compensation (WC) injuries of a musculoskeletal (MS) nature in a large tertiary care hospital and an affiliated community hospital in the 13 years surrounding an institution-wide shift to a 'minimal manual patient-lifting environment' supported with inpatient mechanical lift equipment.
Negative binomial regression was used to model adjusted and discounted payment rates based on full-time equivalents (FTEs), and payment ratios. The risk of higher cost was assessed based on type of injury (patient-handling vs non-patient-handling), hospital, job, age, gender, institutional tenure and time since the implementation of lift equipment. Lagging was used to evaluate the latency of the intervention effect.
Patient-handling injuries (n=1543) were responsible for 72% of MS injuries and 53% of compensation costs among patient care staff. Mean costs per claim were 5 times higher for those over age 45 than those <25 years of age. Physical and occupational therapy aides had the highest cost rates ($578/FTE) followed by nursing aides ($347/FTE) and patient transporters ($185/FTE). There was an immediate, marked decline in mean costs per claim and costs per FTE following the policy change and delivery of lift equipment.
The observed patterns of changes in cost likely reflect the effects of activities other than use of lift equipment, including targeted efforts to close WC claims and an almost simultaneous policy that shifted cost responsibility to the budgets of managers on individual units. Inference was facilitated through the use of longitudinal data on the workgroups and an internal injury comparison.

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: The aims of this study were: (1) to evaluate the effect of manually lifting patients on the occurrence of low back pain (LBP) among nurses, and (2) to estimate the impact of lifting device use on the prevention of LBP and musculoskeletal disorder (MSD) injury claims. METHODS: A literature search of PubMed, Embase and Web of Science identified studies with a quantitative assessment of the effect of manually lifting patients on LBP occurrence and studies on the impact of introducing lifting devices on LBP and MSD injury claims. A Markov decision analysis model was constructed for a health impact assessment of patient lifting device use in healthcare settings. RESULTS: The best scenario, based on observational and experimental studies, showed a maximum reduction in LBP prevalence from 41.9% to 40.5% and in MSD injury claims from 5.8 to 5.6 per 100 work-years. Complete elimination of manually lifting patients would reduce the LBP prevalence to 31.4% and MSD injury claims to 4.3 per 100 work-years. These results were sensitive to the strengths of the association between manually patient lifting and LBP as well as the prevalence of manual lifting of patients. A realistic variant of the baseline scenario requires well over 25 000 healthcare workers to demonstrate effectiveness. CONCLUSIONS: This study indicates that good implementation of lifting devices is required to noticeably reduce LBP and injury claims. This health impact assessment may guide intervention studies as well as implementation of programmes to reduce manual lifting of patients in healthcare settings.
    Occupational and environmental medicine 03/2013; · 3.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIMS: This study evaluates the influence of individual and organisational factors on nurses' behaviour to use lifting devices in healthcare. METHODS: Interviews among nurses were conducted to collect individual characteristics and to establish their behaviour regarding lifting devices use. Organisational factors were collected by questionnaires and walk-through-surveys, comprising technical facilities, organisation of care, and management-efforts. Generalised-Estimating-Equations for repeated measurements were used to estimate determinants of nurses' behaviour. RESULTS: Important determinants of nurses' behaviour to use lifting devices were knowledge of workplace procedures (OR = 5.85), strict guidance on required lifting devices use (OR = 2.91), and sufficient lifting devices (OR = 1.92). Management-support and supportive-management-climate were associated with these determinants. CONCLUSION: Since nurses' behaviour to use lifting devices is influenced by factors at different levels, studies in ergonomics should consider how multi-level factors impact each other. An integral approach, addressing individual and organisational levels, is necessary to facilitate appropriate implementation of ergonomic interventions, like lifting devices.
    Applied ergonomics 12/2012; · 1.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Lifting disabled patients onto a densitometer manually is dangerous for both the patient and the densitometry staff; using a ceiling lift is the preferred method of transfer. This system requires the use of a sling underneath the patient, and then the sling remains underneath the patient as bone density (BMD) is measured, unless extra time is taken to remove the sling. The aim of this study is to determine whether this leaving this sling in place during scan acquisition affects the BMD measurement.Methods: Measurements were done of a spine phantom 30 times by itself, 30 times with the standard sling underneath the spine phantom, and 16 times with the disposable sling underneath it.Results: We found that mean BMD was significantly different versus the phantom alone when a sling was used, due to differences in area, BMC, or both. The disposable sling affected mean BMD to a much greater extent than the standard sling (+1.9% vs -0.41%, p for the difference between slings<0.001). The standard sling did not increase the variance in the BMD measurement compared with the spine phantom alone, while the disposable sling did increase the variance in the measurement of BMD.Conclusion: The commercially available ceiling lift slings affect the BMD of the spine phantom. This effect is expected to persist when measured in patients. This suggests that when lifting a patient onto the densitometer using these slings, it is best to take the time to remove the sling from under the patient after transfer before scanning.
    Endocrine Practice 03/2014; 20(8):1-19. · 2.49 Impact Factor