NIOSH network aggregates healthcare worker injury data
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July 1, 2012
NIOSH network aggregates healthcare worker injury data
A new electronic occupational safety and health surveillance system will allow more focused prevention of healthcare injuries
Starting in 2013, hospitals around the country will be able to compare their occupational illness data with other facilities, track injury trends, and find specific solutions to areas of concern with occupational safety. They will be able to do all of this through a new electronic data collection system known as the Occupational Health Safety Network (OHSN).
Produced by the National Institute of Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control and Prevention (CDC), OHSN is in its final stages of development and will be available to hospitals for voluntary enrollment by January 2013. The new electronic system will serve as a surveillance resource for U.S. hospitals to analyze and report specific workplace illnesses.
"The idea behind the surveillance system is just to use the electronic age to collect data directly from the workplace into NIOSH and organize the data and make surveillance easier in order to tie feedback to the workplace so they can look at opportunities for prevention," says Ahmed Gomaa, MD, ScD, MSPH, lead project officer and medical officer for the Division of Surveillance, Hazard Evaluations, and Field Studies, Surveillance Branch, at the CDC.
Healthcare injuries still high
Although it plans to expand this initiative into other fields, NIOSH decided to concentrate solely on healthcare-related injuries first for two reasons: First, they are significantly higher than any other industry, and second, most of the injuries are preventable.
Despite more awareness and data collection, statistics show healthcare to be one of the most dangerous occupations. In November 2011, a report from the U.S. Department of Labor's Bureau of Labor Statistics issued data from 2010 on nonfatal occupational illnesses requiring days away from work, indicating that injuries had increased in many areas in the healthcare sector. For example:
- The incident rate for healthcare support workers increased 6% to 283 cases per 10,000 full-time workers, almost two and a half times the rate for all private and public sector workers
- The rate among nursing aides, orderlies, and attendants rose 7% to 489 per 10,000 workers
- Musculoskeletal disorder cases with days away from work for nursing aides, orderlies, and attendants increased 10% to a rate of 249 per 10,000 workers
"It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness," David Michaels, MD, assistant secretary for OSHA, said in a press release at the time. "These injuries can end up destroying a family's emotional and financial security. While workplace injuries, illnesses and fatalities take an enormous toll on this nation's economy-the toll on injured workers and their families is intolerable."
With OHSN, NIOSH has found a way to provide more accessible information and insight into the occupational injury data that it is already collecting, Gomaa says. OSHA requires healthcare facilities to collect data on injury rates, but everyone does so using their own unique methods. By adopting a common language and aggregating data from hundreds of facilities, healthcare facilities may find more opportunities for prevention.
"Healthcare has very common injuries above the average private industry and they are preventable," Gomaa says. "We can connect with them directly since most of them use computers in their daily use."
One major benefit to the OHSN system is the ability to compare data from one hospital to another hospital of similar characteristics, such as size and patient load. This provides valuable benchmarking data for hospitals to see how they line up with their peers.
Safety officer and employee health departments can also use the data to look at their own trends month to month, according to type of worker, type of injury, or department.
"There are filters where you can just look at the data broken out by the type of worker, whether it's the nurse or nursing assistant, or physician, or department, so there will be the ability to filter it in different ways," says Susan Sprigg, RN, BSN, public health analyst with Emergint Technologies, Inc., and medical officer at NIOSH.
This approach makes it easier to isolate specific prevention measures, allowing healthcare facilities to hone in on problem areas or occupation, rather than target workplace injuries with broad educational initiatives.
Some may already have this ability with internal software programs, but OHSN takes on the burden of tracking particular trends and measuring those up with similar facilities.
"Historically it's difficult to find work-related benchmarking data that you can compare yourself to," says Chuck Payne, RN, BSN, director of environmental health and safety at Thomas Jefferson University Hospitals in Philadelphia, a participant in OHSN's testing group. "It's just not super easy to find that data to compare a community hospital with 170 beds with another community hospital with 170 beds. And it's impossible to find any benchmarks in one job place."
Payne envisions a scenario where he could make a stronger case to leadership for funding if he finds his numbers are significantly worse than the benchmark among a certain occupation or department.
It's important to note that all information within the system remains confidential. When hospitals compare their data with others, they are looking at an aggregate of similar hospitals, rather than one specific hospital.
"That's important for facilities to know," says Sara Luckhaupt, MD, MPH, project officer and a medical officer in the Division of Surveillance, Hazard Evaluations, and Field Studies at NIOSH. "No one else sees their data; only they see their data."
Gomaa envisions the full cycle of this project in three stages:
- First, develop a common way to collect the data in order to consistently look at what injuries are happening and to whom they are happening
- Second, dissect the data to determine whether the problems of one hospital are unique to that facility, or whether the injury is pervasive across all of healthcare
- Third, implement interventions to reduce the incidence of healthcare injuries
"We offer solutions, so you can look at those and see which ones you can use," Gomaa says. "And it opens an opportunity for everyone to share their success story on our website."
Based on your hospital's injury rates, OHSN offers targeted prevention strategies. Furthermore, based on subsequent data, hospitals will be able to discern whether their prevention initiatives are actually working, providing more effective use of occupational safety funding, education, and training.
"Part of the reason we chose healthcare is because there is research out there on interventions that are effective, so there are solutions that you can try," Sprigg says.
Preparing for enrollment
There are already some testing facilities enrolled in the project to fix holes in the system and see how easy it is for healthcare systems to participate.
"There are some slight differences, but they were broad enough that it was pretty easy to translate my data into their data, and the drop-down screens made it real easy," Payne says. "Now when the comparisons come out we'll actually be comparing apples to apples and oranges to oranges."
Voluntary enrollment begins at the end of 2012 or the beginning of 2013. The more facilities that use the system, the more successful it will be.
"From our perspective we want to make it useful to everybody so it continues to grow in healthcare and in other industries," Gomaa says. "We will do everything we can; however, it's going to depend on how many people participate and how successful this will be and how useful people think the feedback is to them."
Until enrollment begins, hospitals that plan to use the new system can prepare by looking at how their occupational illness data language coincides with that of OHSN, the specifics of which are available on their Web page (hosted on the CDC website).
For example, a hospital may refer to the ICU as "3B," but for the purposes of OHSN, that will need to be defined specially as an ICU.
"One of the things hospitals can start thinking about now is the data elements and how to track these different elements," Sprigg says. "Right now everyone is tracking the location, but they call it by their own personal names. In order to be able to do the benchmarking, they need to translate their data into this common language, and they can even start thinking about that now in preparation for that later."
For those hospitals that already use software programs to track occupational injuries, they will not have to ditch their system in favor of the OHSN model, Luckhaupt says.
Hospitals will simply need to take some of the data they've already entered and translate it to coincide with OHSN language.
Additionally, OHSN leaders are working with some of the more popular commercial software companies to try to integrate data elements and common codes into their system for a seamless integration between the two.
"We hope that hospitals will be able to keep using what is working for them, but just transition to some of these categories and codes," Luckhaupt says.
Standard data elements for OHSN
The following elements are needed for hospitals to participate in the Occupational Health Safety Network (OHSN):
- Information about the worker involved in the event:
- Age (or year of birth)
- Occupation category
- Employee type (on healthcare facility payroll vs. contractor)
- General event/incident information:
- Event ID
- Event date
- Event location
- Event type
- Injury/illness severity (OSHA reportable?)
- Supplemental information for slip, trip, or fall (STF) events:
- Primary hazard contributing to STF
- Supplemental information for workplace violence (WPV) events:
- Perpetrator's possible cause (contributing factor) of WPV
- Supplemental information for patient handling movement (PHM) events:
- Work activity at time of PHM event
The OHSN website also includes standard value sets with corresponding codes, and sample output tables and graphs, so that hospitals can respond appropriately to each of the data elements. Hospitals should also have information available about their own facility, including number of employees in each occupation category, number of beds, and number of annual admissions.
Source: NIOSH (www.cdc.gov/niosh/topics/ohsn).