Academic journal article Scandinavian Journal of Work, Environment & Health

Enhancing the Detection of Injuries and Near-Misses among Patient Care Staff in a Large Pediatric Hospital

Academic journal article Scandinavian Journal of Work, Environment & Health

Enhancing the Detection of Injuries and Near-Misses among Patient Care Staff in a Large Pediatric Hospital

Article excerpt

The United States Bureau of Labor Statistics (BLS) reports that healthcare has one of the highest rates of non-fatal occupational injury/illness in industry, with US$15 860 in average loss per claim settled (1). The Occupational Safety and Health Administration (OSHA) mandates that employers conduct surveillance of workrelated injuries/illnesses (2), but evidence indicates that BLS injury rates underestimate the true risk by up to 70%, necessitating improved surveillance (3-5).

Injury under-reporting is widespread in healthcare (4, 6-11). One study observed that 40% of nurses would not report an injury (12). Others observed a reporting rate as low as 17% of the true value, identifying time constraints, reluctance to report, peer pressure, the "normalcy" of being injured, and reprimands as reasons for under-reporting (6-12). Attempts to enhance reporting through wellness initiatives, education, and incentives have made only minor improvements. Proactive improvements to injury reporting are needed to inform prevention strategies in healthcare.

Whereas common injury reporting systems rely on passive employee reporting (13-16), active surveillance seeks cases through direct contact with individuals (14, 17) or through a proactive search of medical records or databases (14, 18), leading to better detection of injuries (14). Despite its effectiveness, active surveillance is not commonly adopted by employers, probably because of higher resource requirements (17).

We assessed the feasibility of integrating active injury surveillance into a passive institutional surveillance system (ISS) by comparing the frequency of injuries detected via active surveillance with the frequency reported to the ISS.



Participants comprised registered nurses (RN), patient care assistants (PCA) in medical/surgical (med/surg) and psychiatry (psych) units, and mental health specialists (MHS, assigned only to psych units) with >0.6 full-time employment at a pediatric hospital. Med/surg units included gastroenterology/colorectal surgery, solid organ transplant, and cardiac step-down. Psych units included inpatient child, adolescent, neurological, and residential treatment.

The hospital's ISS records events reported by staff to a dedicated phone number. Call handlers ask key questions, and each call lasts 10-45 minutes. We did not alter these operations, but added active voice recording by randomly sampling employees.


The Institutional Review Board approved the study protocol. We collected data on sociodemographic and employment characteristics. Participants learned how to operate handheld digital voice recorders (DVR) to record near-misses or injuries sustained at work during a two-week period. Hospital policy defines an injury as "an event that inflicts physical damage as a result of an employee performing work-related duties, including any exposure to a blood-borne pathogen". We defined a nearmiss as "an incident that did not reach a staff member" (eg, trip but no fall) or "an incident that reached staff but did not cause harm" (eg, a bite by an aggressive patient that did not cause harm due to use of Kevlar gloves) (19). Participants received a laminated card with examples of injuries and near-misses. Full-time employees recorded events for six shifts and part-time staff recorded events for eight shifts. We aimed to collect recordings for 1000 two-week periods to ensure adequate precision [This sample size yields a 95% confidence interval (CI) of 0.48%-1.8% for a rate of 1%]. To assess the acceptability of active surveillance, after each interval we asked participants whether they preferred voice recording, the ISS, or a combined system. Participants were reimbursed $50. Focus groups or interviews with 40 randomly selected participants sought feedback on effectiveness and ease-of-use of voice recording, and preferences. These participants were reimbursed $10.

Data management

Research staff transcribed voice recordings, uploaded the transcripts into a database using NVIVO 10 (QSR International, Melbourne, Australia), and coded events as injuries or near-misses. …

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