Where’s My Worker?

There’s probably nothing more aggravating to your employer clients than when they have sent an injured worker for care in your office or to the ED if after hours and they get … silence.

I was asked recently by a program director about a physician who routinely schedules work comp recheck visits out for 2 to 3 weeks, even after the first visit.

She wondered if there was a resource that listed what the typical time intervals for follow ups would be.

You could consult the ODG guides or MDGuidelines for overall condition duration ranges.

But I don’t think it’s a terribly difficult exercise.

First Aid or OSHA Recordable

One of the first considerations for any injury you are evaluating on the first visit is whether it is a “first aid” case or an “OSHA recordable.”

A first aid case of course requires no follow up most of the time. The worker receives their first aid treatment and is returned to full duty with no time loss. The employer sees the worker return with nothing else to do.

An OSHA recordable case falls in to one or more of:

Days away from work
Restricted duty
Transfer to another job (DART)
Treatment beyond first aid
Death
Diagnosis of a significant illness or injury
Loss of consciousness

Employers really don’t like OSHA recordable injuries. It affects their “mod rate” and jacks up their work comp insurance rates. That’s a whole other discussion. But once you’ve got lost time or restricted duty, they want to minimize that as much as possible.

And if it’s an OSHA recordable, they want to understand exactly why – what specifically prevents them from performing their job duties for their full shift?

With many soft tissue injuries I can’t tell you how many times I’ve seen a patient who has been off duty or on restricted duty for 2 or 3 days ready to return to full duty.

So for most minor, yet beyond first aid cases, I would generally want to see them back in just 2 or 3 days, on the chance they can get right back to full duty.

With more serious injuries, I’d still want to see them back in just a couple days, then it would be rare I’d go out more than a week, for several reasons.

First, I want to make sure there is at least some progress and things aren’t worse.

Have they gotten their meds and is there any problem with them?

Have they made any other appointments for diagnostics or specialty visits?

Have they been able to perform their restricted duty work, etc?

And I will want to start increasing the amount or duration of work as they are capable of doing so.

In my opinion, too much can happen or not happen in 2-3 weeks to manage cases effectively.

Now, if a case has gone on longer than a few weeks and they are off to therapy for 2 weeks and not likely to change job duties during that time, then I will assess at 2 week intervals for the duration of therapy. Usually we are also going to liberalize work duties as progress is made.

I would also schedule a follow up visit shortly after a diagnostic or specialty evaluation so we can review the results or report and make further treatment and job duty decisions based on the new information.

Communication is Key

Where is the employer in all this?

They have to know every step of the way. There should be no question in their mind regarding the worker’s status, prognosis and plan.

My 4 Rules for the Physician (PA, APN) to Call the Employer

After the first visit
Any time taken off duty
Significant change from previous plan
Referred out to specialist, advanced diagnostics, or physical therapy

After Hours / ED visits

EDs are notorious for:

Taking workers off duty unnecessarily
Prescribing medications they don’t need
Referring to specialists they don’t need
Ordering tests they don’t need
Zero communication with the employer

If you are part of a health system offering occupational health services to area employers, you’ve got to get your ED on board with the right work comp mentality.

There needs to be a liaison with your occ health dept to notify you of all new injuries and a system to get them to schedule with you the next day for the “real” disposition in terms of work assignment and follow up care.

Some systems have offered an enhanced case management service to employers that assigns such a liaison to trigger this more efficient flow.

You should have the understanding with your clients that they will notify you of any workers that have had to go to the ED off hours, and routinely schedule with you for the next feasible day.