Literature Review

Lang YC. Employee health services integration: Meeting the challenge. AAOHN J 1998; 46:76-79.

This first prize-winning report also was presented as a poster session at the recent Association of Occupational Health Professionals in Healthcare annual conference in Orlando, FL. It describes the changes and challenges faced by employee health services at three institutions — a large teaching hospital, a smaller neighborhood hospital, and a long-term care (LTC) facility — which integrated into one health care system.

The smaller hospital’s EHS manager resigned, but helped develop a transitional plan that included all services to be offered at the large hospital until all employee records were entered into the computerized database. Upper management support was gained and all employees notified via memos in their mailboxes and a bulletin board posting. Employee meetings were held and a new EHS brochure developed.

EHS staff began a month-long process of reorganizing employee health records. Since neither the smaller hospital nor the LTC facility had computerized records, a secretary and a modified-duty worker were needed to enter the new data. Nurses reviewed each health record, documenting necessary data, which was a massive undertaking due to inconsistent policies and requirements among the three facilities. For example, many LTC employees had not been TB-tested since date of hire because the state had not required TB testing for those employees until two years earlier. Accident reports were missing from the smaller hospital and LTC facility because neither performed workers’ compensation case management, which was standard at the larger hospital.

A "to-be-filed" box from the smaller hospital contained lab sheets and vaccine records dating back five years. All papers had to be reviewed. Many boxes of "non-current" records also were found and had to be reviewed, organized, and shipped to an outside facility for storage.

The new EHS staff consisted of a certified/registered nurse practitioner/manager, two registered nurses, and a secretary. The first service offered was reviewing and managing workers’ comp cases. During that process, "it became evident that post-significant exposure follow-up had to be completed," the report states. Next, employees requiring hepatitis B vaccine were contacted. EHS staff decided to defer TB testing until the next year when all information would be part of the database and employees would be required to have an annual TB test.

Because major services would need to be provided at the larger hospital, staff had to decide how to provide services for employees at the smaller hospital and LTC facility. They decided to telephone-triage all injured employees, who would be treated either at the smaller hospital’s emergency department, sent to the main EHS in a taxi or security van at no charge, or sent home and advised to follow up with the EHS the next working day. The emergency department would fax a copy of the employee’s records to the EHS. LTC employees could either be evaluated at the EHS immediately or the next day.

EHS staff went to each facility to administer TB tests and vaccinations, and to draw blood to check antibody status. This occurred four months after the facilities were integrated.

"During four days of services at the neighborhood hospital, the EHS staff saw 584 employees, drew blood from 271 employees, administered 280 TB tests, interpreted 236 TB tests, administered 92 tetanus boosters, and administered 20 hepatitis B vaccines," the report notes.

The author adds that the goal — to "offer consistent, high-quality services" systemwide — was achieved, "but each day brings new challenges."