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Nurses respond to injuries, input reports
You can’t manage workers’ compensation costs if you can’t track those costs. That basic truth led OSF Saint Francis Medical Center in Peoria to rethink its system, beginning with the first report of a work-related injury. Instead of filling out a paper form and handing it to a manager, injured employees now dial a call center and talk to a trained nurse. She logs the information about the injury and schedules an appointment for the employee at the most appropriate level of care.
This more efficient method, which directs employees to hospital-based care rather than private physicians, has saved OSF Saint Francis more than $41,000. It has provided more accurate information about the cost of injuries and enabled the hospital to respond more quickly to unsafe conditions.
The hospital now has a database of workers’ compensation information. Previously, analyzing injury trends meant flipping through stacks of paperwork. Now, managers easily can determine their most frequent injury, whether the injury rate is going up or down, and how much the injuries are costing the hospital.
"Knowledge is power. I really believe that," says Christine Abercrombie, RN, BS, COHN-S, regional manager for occupational health, who will present the new reporting and tracking system at the upcoming conference of the Association of Occupa-tional Health Professionals in Healthcare (AOHP). "By using this, we have data in which to make decisions as to where we are going to focus our energies," she points out.
The old system at OSF Saint Francis led to nothing but frustration. Sometimes the workers’ compensation case manager didn’t even know about a work-related injury until she saw an emergency department (ED) bill; and the ED may not even have been an appropriate place of treatment for the injury.
"We surveyed managers; we surveyed injured workers; and we found out no one was happy with the process," says Denise Strode, RN, COHN-S/CM, clinical case manager at the OSF Saint Francis Center for Occupational Health and executive president of AOHP.
The hospital used the Six Sigma approach to quality improvement — using an interdisciplinary team to "define, measure, analyze, improve, and control" a problem. Staff discovered that 71% of the accident reports did not comply with reporting requirements either in timeliness or information gathered. Some 70%-82% of ED visits following work-related injuries did not need that level of treatment. Cases involving private physicians had more lost workdays.
Some of the reporting errors stemmed from the inefficiency of the paper system. For example, employees couldn’t always get assistance from their managers to properly complete the paper forms, a survey found. Meanwhile, both managers and employees were dissatisfied with the restricted work program, which was supposed to find meaningful work for employees who couldn’t return to their full duties.
The team decided to use the existing call center, which employs trained nurses to triage patient calls and provide advice and referrals. The nurses were retrained to handle work-related injuries and employee health concerns. They take the initial report and input it into a database. Employees no longer need to fill out paper forms, and they receive an immediate response to their injury.
If an injury is life-threatening, the employee goes to the ED immediately and calls the report into the call center later. But in all other cases, the triage nurse directs the employee. For example, for priority care, such as someone who smashed his hand in an accident and is experiencing pain and swelling, the call center nurse schedules a same-day appointment with the hospital’s occupational medicine clinic. For someone with a nonurgent problem, such as a worker experiencing recurrent bouts of tingling in her wrists, the call center nurse will schedule an appointment within a day or two. This triage and scheduling reduces inappropriate ED utilization and saves the hospital about $16,000 a year, Abercrombie explains.
Better use of case management
The call center also strengthened the hospital’s workers’ compensation case management. When employees went to a private physician for a work-related injury, there often was a time lag before the case manager even became aware of the injury. The hospital, which is self-insured, paid the medical bills outright instead of handling the costs internally through the hospital-based occupational medicine program.
With better management of the internal cases, employees returned to work after 2.3 days instead of 8.1 days, for a savings of $25,000 a year, says Abercrombie. Employees still can choose to go to a private physician, but they are satisfied with the convenience of the call center and its scheduling, she says. "Not nearly as many [injured employees] treat with their primary care physicians now because they get taken care of so quickly with the call center," Abercrombie says.
Employees also are more satisfied with a revamped restricted work program. that requires managers to find appropriate modified duty tasks, allowing employees to return to their department.
Further savings will come from injury prevention, as the hospital targets high-cost and high-frequency injuries, she says. For example, by analyzing a year’s worth of data, the hospital found that needlesticks and blood exposures were by far the most common injury, with 234 cases that cost a total of $160,504. But the greatest cost per case came from pushing and pulling — anything from heavy equipment to laundry carts — with an average cost of $6,068 per workers’ compensation claim. (See chart.)
The hospital now is working to reduce those injuries. "We’re trying to get smarter and do things better," says Abercrombie.