Work organization and patient care staff injuries: The impact of different care models for “alternate level of care” patients

Ostry, Aleck; Yassi, Annalee; Ratner, Pamela A.; Park, I.; Tate, R; Kidd, C.

doi:10.1002/ajim.10277

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…These units also feature staff reorganization where acute nursing is reduced and personal supports as well as allied health professionals are increased. Such units are have been found to reduce staff injury [56,57]. Likewise, the use of rehabilitation has been shown to reduce delayed discharge rates [58].…”

Section: Discussionmentioning

confidence: 99%

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

Costa

Poss

Peirce

et al. 2012

BMC Health Serv Res

105

100

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BackgroundAcute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.MethodsPopulation-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.ResultsALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27 day mean deviation, 99% CI = ±14.6), psychiatric diagnosis (13 day mean deviation, 99% CI = ±6.2), abusive behaviours (12 day mean deviation, 99% CI = ±10.7), and stroke (7 day mean deviation, 99% CI = ±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.ConclusionsA small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.

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Section: Discussionmentioning

confidence: 99%

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

Costa

Poss

Peirce

et al. 2012

BMC Health Serv Res

105

100

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show abstract

“…Fuortes et al (1994)14 found the incidence of low-back injury in CAs was 3.3 times higher than in RNs and LPNs. Ostry et al (2003)36 found that in acute care, LPNs aggregated with CAs were more likely than RNs to experience: any injury (1.59 times), patient-care injury (1.80 times) and violence-related injury (3.25 times). The different tasks between occupations may explain injury differences between occupations and these differences agree with the findings from previous studies using facility-specific data (e.g., Ostry et al ) 36.…”

Section: Discussionmentioning

confidence: 99%

“…Ostry et al (2003)36 found that in acute care, LPNs aggregated with CAs were more likely than RNs to experience: any injury (1.59 times), patient-care injury (1.80 times) and violence-related injury (3.25 times). The different tasks between occupations may explain injury differences between occupations and these differences agree with the findings from previous studies using facility-specific data (e.g., Ostry et al ) 36. However, as suggested above, facility-specific data produce higher injury rates than rates reported by Workers Compensation Boards, as the generic denominator data used by Compensation Boards tend to result in lower injury estimates than the actual exposure risk.…”

Section: Discussionmentioning

confidence: 99%

Work-related injury among direct care occupations in British Columbia, Canada

Alamgir¹,

Cvitkovich

Yu³

et al. 2007

Occup Environ Med

Self Cite

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Objectives: To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada. Methods: Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care). Results: CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%). Conclusions: Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.

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“…Studies have found that violence-related injuries and musculoskeletal disorders are more common in direct care workers compared to other health care professionals (Fredriksson et al, 2002; Fuortes, Shi, Zhang, Zwerling, & Schootman, 1994; Ostry et al, 2003). Research has also shown that direct care workers have less control over their work environment, fewer opportunities to make independent decisions, and higher levels of job strain than other occupational groups (Morgan, Semchuck, Stewart, & D’Arcy, 2002; Sullivan, Kerr, & Ibrahim, 1999).…”

Section: Discussionmentioning

confidence: 99%

Resident Aggression Toward Staff at a Center for the Developmentally Disabled

West¹,

Galloway²,

Niemeier³

2014

Workplace Health Saf

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Few studies have examined factors contributing to nonfatal assaults to staff working in residential care facilities. The authors evaluated resident assaults toward direct care/nursing staff at an Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR), which included observations of work areas, employee interviews, calculation of injury and assault rates for 2004 to 2007 from Occupational Safety and Health Administration Logs, and review of state ICF/MR guidelines. Most staff interviewed reported having been injured during physical restraint of a resident and the average rate of injury from assault at the center evaluated was higher than the average national rates for the health care and social assistance sector for the same time period. The center lacked policies for a safe workplace. The authors recommended review and maintenance of workplace violence prevention policies and developing a post-incident response and evaluation program to assist staff in coping with the consequences of assault and/or occupational injury.

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Work organization and patient care staff injuries: The impact of different care models for “alternate level of care” patients

Abstract: The way in which ALC care is organized in hospitals affects the risk and severity of injuries among patient care staff.

Cited by 13 publications

References 9 publications

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

Work-related injury among direct care occupations in British Columbia, Canada

Resident Aggression Toward Staff at a Center for the Developmentally Disabled

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