Successful Occupational Medicine Programs
As with many other industries, in order to run a successful occupational medicine program, “service” has to be delivered from the customer’s perspective. You’ve set up your center and trained your staff for drug screens, worker’s comp and a slew of pre-placement and OSHA regulated physicals. Your marketing has paid off and you’ve got employers coming in for clinic tours and new employer-referred patients coming in daily.
Even with a successful occupational medicine program, there are a few pitfalls that can make your clients look elsewhere for employer related services.
Three main buckets of service issues concerning occupational medicine clients we see are:
- Long wait times – appointment availability
- Delays in communication for getting reports of drug screen results, back to duty status for work comp patients and pre-placement physicals
- Unnecessary or prolonged time loss for worker’s compensation patients, leading to higher OSHA recordables.
Long wait times
Long wait times are multi-factorial problems but these folks are also on the clock so it costs plenty to the employer. Here are some ways to move occmed / work comp patients along faster:
Drug screens (or TBST, other pre-hire or pre-placement testing with no provider visit) – make one MA per day responsible for getting drug screen donors back as soon as possible, this taking precedence over their other duties. Not needing to see a provider should move through the whole procedure in 20 min or less.
To avoid other patients in the waiting room sensing they were taken ahead of them, it can easily be explained or commented on that they don’t need to see the doctor, they are just here for a test.
Work comp injuries – Have standing orders for certain xray studies to go ahead and get done based on “non-weight bearing ankle injury” or “loss of motor ability” or “FB in open wound”, etc. OR if not comfortable with MA/tech assessment, have a provider always quickly assess if any studies are needed before doing a full visit/assessment and get that rolling.
If it is standard practice to use elastic wraps, aircasts, camwalkers, wrist splints, etc for common injuries, have the MA go ahead and get those ready to go upon intake rather than waiting until after the provider has seen. Not apply them yet, but have them immediately available so they can be applied and patient discharged right after provider is done.
To be most efficient, this is best when supplies are in or near the exam rooms where the patient is seen. And only the most basic for the condition. For instance, I wouldn’t pull out an ace wrap, air stirrup and camwalker for every ankle sprain, but and ace and air stirrup would be very common.
You don’t want to create a feeling on the patient’s part that the injury is more serious by hauling out the “big guns” for everything, so have some communication about what works best in your clinic with your providers and staff.
<<BUT be careful not to use OSHA recordable rigid devices when an elastic wrap and no time loss will do>>
For lacerations, have standing orders for the MAs to get the typical surgical set up ready and waiting for the provider, with the proper syringes, needles & anesthetic bottles lined up for provider choosing, the right size sterile gloves for whomever is one duty that day (they should know who is size 7 and who is 7.5, etc)
Eye FB, get irrigation going AFTER a visual acuity and quick provider assessment.
(Any of these can be sought out for a quick verbal as well, the point is not to wait another 20 min for the doc to enter the room)
Other conditions such as allergic reactions, burns, wounds can have orders for meds to be ready (not given) like glucocorticoid injections, nebulizer for inhalation exposures, wound trays, etc.
The providers’ input should be elicited as they’re going throughout their day with these cases, they can come up with ideas for other procedures, supplies or setups that would have been helpful to instruct staff for the next time.
PrePlacement exams – Most of these testing procedures should be protocol driven, not awaiting physician order. Providers need to focus only on ability to perform the essential job duties, not spend time on any preventive medicine or diagnostic issues. If additional info is needed from PCPs and not readily available, they should be rescheduled to come back when that information is available, preferably they bring it with them.
Drug screen – negative results to “designated employer representative” (DER) within 24 hours. Positives 24-48 h depending on MRO review, but once in the office, has to be reported to employer same day
PrePlacement physicals – If no issues, it is best if someone from the office calls the employer immediately to report they are cleared for the job, and the one page report should be faxed over (sent to employer portal if available) same day. If there are labs coming back in 2 days, you can’t make the employer wait another several days because the ordering doc isn’t in that day.
They don’t care if the ordering doc isn’t in that day, not their problem. Providers need to review any labs that are work comp or occmed related during their shift and get the information to the employer that same day. If you are insisting that only the ordering doc can sign off on these and the client has to wait even one more day to get a report, that needs to change.
If it’s something truly complicated, then call the ordering doc and run the result past them to get input. Or at the very least let the employer know you have the information but really need the ordering docs’ input for a determination, are they OK waiting another day or whatever.
Work Comp – Employers should be called by the provider in these circumstances:
- First visit for new injury
- Significant change in condition, plan or prognosis
- Referral to specialist, PT or outside diagnostic
- Anytime taken off duty
A staff member can make the call when he/she knows the provider will be free OR have contact numbers available in the chart so the provider can call and at least leave a message. They should document that the call was made.
Best Practice tip: these provider calls are part of the “check off” protocols that must be completed for each patient. Providers not falling in line with this are counseled and followed up.
All visits – the Return to Work status report should 1) accompany the patient and 2) be faxed or secure emailed to the employer immediately following the visit. Even better, every employer gets a call from the staff indicating their status after each visit, followed by the written status or work clearance report.
Communication is the main reason a client will bypass several other clinics to come to yours! (Excellent care notwithstanding)
The drug screen MA can also be the designated occmed/work comp liaison for the day, making sure all these calls and reports get done. S/he can keep the criteria for provider calls handy and review that it applies to each case throughout the day for calls.
Providers really need to understand OSHA recordables, return to work philosophy and transitional work/modified duty. Nothing burns your clients more than keeping injured workers off duty unnecessarily. And you really do a disservice to patient/employee as well. There is a huge body of evidence confirming work is good therapy – physically, mentally and economically.
You can learn more about this in our free Occupational Medicine Primer eBook, accessible through your free membership.
Don’t let your successful occupational medicine program get derailed by these pitfalls. Keeping a lid on wait times, getting reports out in a timely manner and getting injured workers back to productive work sooner is good medicine and will delight your occupational medicine clients.