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

• Published in: American journal of industrial medicine Vol. 44; no. 4; pp. 392 - 399
• Main Authors: Ostry, Aleck S., Yassi, A., Ratner, P.A., Park, I., Tate, R., Kidd, C.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2003; Wiley-Liss
• Subjects: Accidents, Occupational - statistics & numerical data; acute-care hospitals; Adult; alternate level care patients; Biological and medical sciences; British Columbia - epidemiology; Health participants; Humans; Logistic Models; Medical sciences; models of patient care; Models, Organizational; Models, Statistical; Nursing Staff, Hospital - organization & administration; Nursing Staff, Hospital - statistics & numerical data; Occupational Diseases - classification; Occupational Diseases - epidemiology; patient-handling injury; Progressive Patient Care - organization & administration; Progressive Patient Care - statistics & numerical data; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Assessment; time-loss injury; Trauma Severity Indices; violent injury; work organization; Wounds and Injuries - classification; Wounds and Injuries - epidemiology; Canada; British Columbia; North America; America; Human; work organization; violent injury; Health staff; Violence; Injury; time-loss injury; patient-handling injury; Occupational exposure; Care; Occupational accident; Work safety; alternate level care patients; Nursing; acute-care hospitals; models of patient care; Cohort study; Hospital; Job engineering; Elderly; Occupational medicine; Nurse; Handling
• ISSN: 0271-3586; 1097-0274
• DOI: 10.1002/ajim.10277

Background The number of elderly patients who do not have acute‐care needs has increased in many North American hospitals. These alternate level care (ALC) patients are often cognitively impaired or physically dependent. The physical and psychosocial demands on caregivers may be growing with the increased presence of ALC patients leading to greater risk for injury among staff. Methods This prospective cohort study characterized several models for ALC care in four acute‐care hospitals in British Columbia, Canada. A cohort of 2,854 patient care staff was identified and followed for 6 months. The association between ALC model of care and type and severity of injury was examined using multinomial and ordinal logistic regression. Results Regression models demonstrated that the workers on ALC/medical nursing units with “high” ALC patient loads and specialized geriatric assessment units had the greatest risk for injury and the greatest risk for incurring serious injury. Among staff caring for ALC patients, those on dedicated ALC units had the least risk for injury and the least risk for incurring serious injury. Conclusions The way in which ALC care is organized in hospitals affects the risk and severity of injuries among patient care staff. Am. J. Ind. Med. 44:392–399, 2003. © 2003 Wiley‐Liss, Inc.