by Virginia “Ginnie” Halling, PT
When a worker sustains an injury on the job, a cascade of events begins that becomes increasingly challenging to manage as time goes on. As is well known, the workers’ compensation system is not an easy system to navigate. Rules and laws, as well as the interpretation of those rules and laws, can make even seemingly straightforward situations complex. Therefore, managing workplace injuries truly from the first minute is critical to keeping a worker gainfully and productively engaged, or even employed. Proper workplace injury management is likewise crucial in managing cost, as well as days away from work or restricted days.
For many employers across the United States, a shortage of qualified workers is reaching crisis level. Employers need their workers to be at work and as productive as possible. Employers depend on the healthcare system to get their employees back to work. Employees depend on the same healthcare system to get them “better” and not place them in harm’s way. Physicians are called upon to release their patients back to work as soon as possible, but the Hippocratic Oath underlies their professional existence. Therefore, they must also “do no harm” and protect the patients they serve.
The workers’ compensation system requires all of the parties mentioned above to work diligently to restore the worker to his/her pre-injury status and job. In spite of this directive, and in far too many instances, all of these parties are operating with an absence of adequate information about the functional/physical nature of the job to which the worker is to return. Even when the information is available, it is often not utilized in a timely manner.
Functional Ability: A Crucial Puzzle Piece
A major challenge is to secure adequate functional/physical information about the job and utilize this information early in the management of an injured worker. The worker’s functional abilities can be measured in frequent/timely intervals to keep return to work planning and goals as an integral part of managing the worker throughout medical intervention and recovery. This functional/physical information cannot be secured without the engagement of the employer. Employers can benefit from function-based job descriptions in a number of areas that assist with the successful management of their employees. Managing workplace injury is one.
The function-based job description can help all parties understand the job’s physical nature and communicate more effectively. It can open the door to effective, well-understood testing of workers’ functional abilities at any given point and communicating those abilities effectively. The planning process—especially, engaging the worker and supervisor in return to work planning—is particularly aided.
Historically, healthcare providers have not had this information and are used to having to estimate their patients’ work abilities. The healthcare provider turns to the injured worker for information in the absence of any other available information. If there is no other choice, the subjective report of the patient is all they have to go on. Work restrictions are a result of this approach. If the patient is reluctant, the cautious physician is left with little choice but to wait until convinced that recovery is complete and assume this means the worker is able to return to work full duty. This, for many reasons and with numerous combinations of factors at play, has proven to be a prolonged, expensive method.
As the employer must do their part, healthcare professionals also must do theirs. When called upon to release workers back to work (physicians), rehabilitate a worker for return to work (therapists), or recommend when return to work is safe (all), the healthcare professional must consider putting in place procedures that seek out this objective job information. Whether it is to insist that the insurer or case manager procure it, or provide the means to procure it (ie, offer to send a staff member out to perform the job analysis), healthcare providers should insist on receiving objective job information with adequate detail before answering questions about return to work. The healthcare professional is otherwise forced to provide an educated guess that he or she must defend. It is no wonder that some healthcare workers prefer to avoid the workers’ compensation system.
The following companies offer products and services that can be helpful for industrial rehabilitation and work injury assessment:
DSI Work Solutions Inc
WorkWell Prevention & Care
Comparing Subjective and Objective Models
So what does it look like when objective job information is engaged early in the process? Following is an example of a work injury case approached first from the subjective model, and secondly the objective model. This case presentation is intended to spark thinking, conversation, and perhaps debate.
Case: A grocery stocker at “a grocery store near you” sustains a right shoulder injury while stacking 40- and 50-lb sacks of pet food at 5 am—soon after starting the shift. The worker immediately reported to the supervisor, was clearly in distress, unwilling/unable to continue working, and therefore was taken to the emergency department. The result: prescription medication and placed off work until seen by an orthopedic physician (referral made).
Subjective example of return-to-work progression:
FROM THE JOB DESCRIPTION: Physical Demands: The job requires frequent lifting of up to 50 lbs.
The orthopedic physician sees the worker the next day and decides to treat conservatively. Work restrictions are written: No lifting greater than 10 pounds, and no reaching above shoulder level with the right arm. The worker is referred to physical therapy for evaluation and treatment. Follow-up with the orthopedic physician is scheduled 2 weeks later. The employer receives the restrictions and places the worker in an office filing papers and reviewing safety videos. The worker is not happy about the work assignment.
The therapist performs the initial evaluation 2 days later and begins treatment per evaluation findings and treatment protocol. The worker is interviewed regarding home and work functions, and conservative advice is given. The worker complains about the office job, stating that it caused more shoulder pain than what is caused by moving around. The therapist offers suggestions.
At the end of 17 days, the therapist documents that the worker has met 75% of the treatment goals for pain reduction and improved mobility and functional use. Two more therapy visits are recommended to meet stated goals. The physician concurs, and visits are approved. The next physician visit is scheduled for 2 weeks later. Restrictions remain unchanged. The worker continues in the light-duty office job—unhappily. The worker has heard remarks about his situation in the lunchroom. Two visits later the therapist discharges the worker with goals for reduced pain and improved mobility met. The physician evaluates the patient at the next visit, agrees with the therapist, and releases the worker back to full duty.
Days away from the worker’s job: 31
Totals days until return to full duty: 31
The employer and employee are hoping everything will be fine now that the doctor has released the worker back to full duty.
Accurate job function information and job function-based testing:
The orthopedic physician issues restrictions pending the RESULTS from the Job Function Test (see Table 1). The therapist provides the job function-based testing 3 days postinjury. The results are as follows:
The physician reviews the results and concurs that the worker can perform the job functions as outlined, and signs off on the document. The employer reps (safety and supervisor), who were pivotal in developing the modifications, and the worker agree to the return-to-work conditions.
Therapy continues, and 1 week later (10 days postinjury) the test is repeated, revealing progress in lift ability but not yet full capability. The document is faxed to the orthopedic physician, who concurs and signs off (see Table 2).
Therapy continues, and 1 week later (17 days) the test is repeated, revealing the worker now has regained full work capability (see Table 3).
Worker has returned to work full duty and continues therapy until therapeutic goals have been met.
Total days away from the worker’s own job: 3
Total days until return to full duty: 17
There is confidence in the work recommendations by all and what the worker can do is clearly understood by all, given the language used to describe what the worker CAN do. The worker has not “disconnected” from the job and has confidence with work activities because of the testing experience.
Treatment costs, in this example, are not the major cost driver. With the total days away from the worker’s own job being reduced from 31 to 3, as well as the number of days taken to return to full duty reduced from 31 to 17, there is real cost savings to the employer. In other cases, medical costs are often reduced as well. The employee is much less likely to be unhappy, and that can result in less likelihood that an attorney will be sought. Most importantly, the employee and employer’s needs have been met in a timely, objective, and respectful manner. PTP
Virginia “Ginnie” Halling, PT, is CEO of DSI Work Solutions. For more information, contact PTPEditor@medqor.com.