Cut pre-placement exams without cutting corners

Mayo study shows streamline approach works

By streamlining your pre-placement screening and eliminating a full medical exam, you can save time and money without missing any important information. That was the conclusion of a study at the Mayo Clinic in Rochester, MN. Nurses used a two-page questionnaire that asks about ability to function, lifestyle issues such as alcohol intake, and past exposure to potentially toxic substances such as formaldehyde and latex.

Any red flags on the questionnaire trigger a review by a physician. The streamlined process could save more than $1 million a year, notes William Buchta, MD, MPH, medical director of the employee health/occupational medicine program, who has not yet published his study. (See the questionnaire.) "It’s a function-based questionnaire, which is a divergence from the medical model," he says. "All we want to know is what you can do and what you can’t do."

The streamlined approach isn’t a way to cut corners. It’s a better approach, Buchta contends. "A whole general medical examination was not only unnecessary, but it obscured the purpose of the exam, which was, Can this person do the essential functions of the job?’ We don’t need diagnoses. We need [to assess] ability to function."

For example, the medical exam might uncover health problems that aren’t work-related, such as acid reflux or high blood sugar. The new hire may then be referred to another physician — but they aren’t even employed yet by the hospital. "Some of these people may have no benefits whatsoever. If we start ordering lab tests, they’re going to end up paying out of pocket," he explains.

Yet changing a longstanding practice can be difficult. At Mayo, Buchta formed a task force that included human resources, safety, and employee health. The task force worked on a questionnaire that would pinpoint the issues that are most important in a pre-placement exam. It started out with the most basic ones: Do you have a disability? Do you have restrictions? Despite the restrictions, can you do the job you’ve applied for? "Those three questions answer 90% of what we need to do," he notes.

The task force considered what health issues were most likely to lead to a decision not to place someone in a position. Medical disqualification most often occurred due to recent history of substance abuse. So it developed questions that relate to illegal drug abuse and alcohol intake. Ten questions deal with functional issues, such as the use of arms and legs. The form also includes some questions related to health promotion, which have no impact on hiring status but can be used in a wellness program after the person becomes an employee. New hires undergo a communicable disease screening.

The task force then tested the form with 175 new hires over a two-month period in 2003-2004. Employee health nurses began incorporating the forms in May 2003. By December, the nurses relied on the questionnaires to make pre-placement decisions.

The new hires still had a general medical exam. "Out of 175 people, one person was given some restrictions after the exam that were not deemed necessary before the exam, but it was for a condition the examiner was already aware of based on history," Buchta explains. "That gave us some confidence that we’re doing the right thing."

Mayo began using the new system in January 2005. He expects about 10% of the pre-placement reviews to require a medical exam. Meanwhile, the nurse practitioners that once spent much of their time conducting medical exams instead will focus on health risk appraisals and health promotion. The occupational medicine physicians will be able to spend more time working with outside clients. "It just frees us up to do more productive work," Buchta adds.