Information revolution: New national system to track occupational injuries

NIOSH targets slips, falls, patient handling, violence

Information is power — the power to prevent occupational injuries. That is the fundamental concept behind a new national surveillance system that will help health care employers track their injuries and compare them to other, similar facilities.

“The purpose is to collaborate in preventing exposure and injury among health care workers,” says Ahmed Gomaa, MD, ScD, MSPH, medical officer in the Division of Surveillance, Hazard Evaluations & Field Studies at the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati. “In order to treat any disease, you have to know the diagnosis first. You have to see what caused this [workplace] violence, injury, or musculoskeletal disorder.”

This summer, hospitals will be able to enroll in the Occupational Health and Safety Network, an online reporting system. Information is currently available at www.cdc.gov/niosh/topics/ohsn/. Initially, NIOSH will collect data on slips, trips and falls, patient handling injuries and violent events. That may eventually be expanded to include needlesticks, asthma, respiratory disorders and skin disorders.

An Internet-based system will allow for confidentiality as well as swift feedback and benchmarking, says Gomaa. “We want to transform this data into information and get it back to the frontline worker,” he says.

Currently, the primary source of national data on occupational injuries and illnesses is the U.S. Bureau of Labor Statistics, which conducts an annual survey of about 200,000 employers. Some workers’ compensation insurers also track data. The BLS gives an incomplete picture of occupational injuries, critics say.

A more complete surveillance system would incorporate multiple sources of data on occupational injuries and illnesses, says Kenneth Rosenman, MD, chief of the Division of Occupational and Environmental Medicine at Michigan State University in East Lansing and a national expert on surveillance of occupational injuries and illnesses.

The NIOSH initiative could be a step forward, if a significant number of hospitals participate and if they represent different hospital types and geographic regions, he says.

“It’s good for the individual hospitals that participate,” says Rosenman. “They’ll get a better sense [of their injuries] and they’ll get some feedback that they can use for targeting and prioritizing interventions.”

Three ways to send data

Perhaps the single most important attribute of the new system is that it is user-friendly. NIOSH worked with 80 pilot facilities to find the best way of collecting data. They found that facilities varied in their methods of tracking occupational injuries, so the OHSN system works in three ways.

“If you are a small hospital collecting on Excel sheets, we give you the tools to do that,” says Gomaa. “If you’re using commercial software, we give you a mapping tool that makes it very easy to convert [the data].

NIOSH also is working with the major occupational health software vendors to facilitate reporting. “We wanted to make it easy for them to transmit the data to us in a standard form,” he says.

Creating standard definitions is critical to benchmarking. “One of the biggest challenges is to get facilities to collect data in similar ways,” says Sara Luckhaupt, MD, MPH, a medical officer with the Surveillance Branch.

While the OHSN will be voluntary, it will offer a window into occupational risks, says Gomaa. “By collecting data in a consistent way, you’re going to benefit instantly,” he says.

The NIOSH system will include details and denominators that aren’t available from BLS or other sources. For example, hospitals can compare their rates based on full-time equivalent employees or number of patient beds. They can compare injuries in adult critical care with adult specialty care. They can compare injuries associated with repositioning in bed with injuries related to performing patient hygiene. They can determine how many injuries occurred when there was no patient handling equipment available or if the available equipment wasn’t used.

Hospitals provide information on event severity, so they can track events that are not OSHA-recordable (that require first-aid only or no treatment).

Surveillance and solutions

Ultimately, the OHSN surveillance system will become a community of employers seeking to reduce their occupational risks. The site will include information about successful interventions to reduce injuries, with links to resources. It will even host an interactive forum, in which occupational health professionals post comments and questions.

“You can cut and slice your data in many, many ways,” says Gomaa. “Once you figure out what your weak area is, then resources are in front of you. You can see if [your safety intervention] is really improving anything and you can share your experiences.”

The surveillance system also will be shaped by users’ feedback, he says.

Meanwhile, efforts continue to expand the scope of national surveillance of occupational injuries. The Council of State and Territorial Epidemiologists in Atlanta is bringing together stakeholders to create a multi-dimensional surveillance system.

Ideally, a surveillance system should include a mechanism for employees to report occupational injuries, says Rosenman. NIOSH has added some questions to National Health Interview Surveys or states have added questions to the Behavioral Risk Factor Surveillance System, but a more consistent employee component is needed, he says.

After all, sometimes employees seek care from their personal health providers rather than reporting occupational injuries or illnesses, or they may even self-treat, Rosenman notes. But he says OHSN offers promise of obtaining important new information.

“If you did this [surveillance] on a random basis or if you had enough [participating hospitals in OHSN] and if you incorporate a workers component, I think it would be a major step forward,” he says.

So far, about 200 to 300 hospitals have expressed interest in OHSN. “The real test is when we open this for enrollment,” says Gomaa.