Success story: Boosting annual health screens

Too many employees lost to follow-up

Sometimes the routine becomes routinely ignored. That is what had happened at North General Hospital in New York City with annual health assessments.

The hospital viewed them as an important encounter for immunizations, TB screening, fit-testing, and other fitness-for-duty issues, and Joint Commission surveyors asked about employee health records. But too often, the employees themselves let the appointments slide.

"It was easy for them to get lost to follow-up for some particular reason," says Linda Primus, MS, PA-C, employee health services manager. "It makes it quite difficult to monitor the employees for their own safety."

Employees received a letter reminding them to come for their health assessment during the month of their birth date. It was difficult for supervisors to know which employees had complied. By midyear in 2006, when Primus arrived at North General, only about 20% of the employees had completed their annual health assessment. Annual assessments had previously been as low as 47%.

"If we keep on going at this rate, we're not going to make it [to 100%]," Primus realized. As tedious as it was, she began a review of employee charts to identify the employees who had missed their assessment.

Then, working with human resources, she changed the system. Instead of coming to Employee Health during their birth month, employees would receive their assessments with their departments during a designated month. For example, nursing received their assessments during January and February.

With the new system, managers could help keep track of which employees had completed the assessment, and it was easier for employees to remember when to come. Employee Health often lacks manpower, but now managers were able to assist, says Primus. "We have to learn how to collaborate with the other departments," she says. "They were very helpful in bringing up our numbers."

The new method also allowed for better health and safety education of employees by department. For example, Primus discovered that only about 50% of employees with bloodborne pathogen exposure had received their hepatitis B vaccine. With focused education, more employees agreed to the vaccine and the coverage now is about 85%.

As cases of mumps appeared in New York state, North General took a new policy on mumps immunity. All employees must either have documentation of the MMR vaccine or previous mumps infection or must have a titer. If a mumps outbreak occurs, "we're at ease because the proof of immunity is already there," she says.

One more fundamental policy change made it clear that the hospital placed a high priority on the annual health assessments: They became a condition of employment. Employees who neglect their annual assessment first receive a reminder from Employee Health that noncompliance could lead to suspension without pay. Then human resources and the department manager are notified. If the employee still doesn't comply, she or he faces disciplinary action.

All departments have had 100% compliance — and no one required disciplinary action, Primus says.