7 Year Study at Major US Medical Center Documents Significance of Work-Related MSDs

Over a 7-year period, 2,849 work-related musculoskeletal disorders (WMSDs) were suffered among all hospital employees of a major medical center – a crude rate of 2.8 per 100 full time employees per year (FTE).  A total of 48,911 lost workdays resulted from these injuries, converting to a rate of 47.6 lost workdays per 100 FTEs.  The occupational group that sustained the greatest number of injury/illnesses was inpatient nurses, who most commonly became injured through patient handling (63.2 percent).

The study, conducted at Duke University Medical Center, attributed these injuries to:
• patient handling (31 percent)
• lifting, pushing, or pulling of work equipment (31 percent)
• slips, trips, and falls (30 percent)
• walking/body movement (6 percent)
• computer work (4 percent)

Occupational groups that experienced the greatest incidence of injury/illness were (claims per 100 FTE):
• lab animal technicians (females – 25.9, males – 13.2)
• laundry staff (females – 11.3, males – 18.7)
• nurses’ aides (females – 12.1, males – 11.8)
• dietary services (females – 10.8, males – 9.0)
• medical supply assemblers (females – 15.0, males – 5.6)

Occupational groups that experienced the highest lost work day rates were (number of days lost per 100 FTE):
• housekeepers (females – 607.9, males – 151.3)
• nurses’ aides (females – 297.3, males – 344.8)
• medical supply assemblers (females – 164.5, males – not reported)
• lab animal technicians (females – 88.0, males – 22.9)
• laundry staff (females – 75.0, males – 52.1)

Trends over the 7 year study revealed an overall decline in incidence rate (3.3/100 per FTE in 1997 to 2.4/100 per FTE in 2003).  Some occupational groups experienced a significant injury/illness decrease (nurses’ aides – from 16.4 per FTE in 1997 to 7.8 per FTE in 2003) while others had an increase (housekeepers).

Study Design
Subjects
From 1997 through 2003, an average of 19,487 workers were employed per year at the Duke University Medical Center (including off-site clinics, laboratories and office staff).  Half of this number were considered part-time employees (they worked either part-time for a year or worked part of a year).

Each employee was identified as to occupation, duration of employment, gender, race, and age.

Data Evaluation
Acute musculoskeletal injuries and cumulative trauma disorders were identified among accepted workers’ compensation claims for each year.  This data set was further reduced by requiring cases to have causation codes of fall/slip, exertion, lifting, push/pull, repetitive motion, or bodily reaction.

Restricted and lost workday information was also tracked for each included case.

Outcomes of Interest
Number of:
• claims
• claims characterized by work restrictions
• claims characterized by lost work days

Also, the total number of lost work days per claim was calculated.

Other Key Findings
1) Those with 5 or less work-years or more than 20 work-years had lower rates of lost workdays.
2) An increase in the number of lost workdays was associated with increased employee age.
3) Clerical staff sustained only 13 percent of their injury/illnesses from computer work; almost half came from slips/trips/falls.

The Bottom Line – How This Applies To Ergonomists
At a time when health care costs are considered a significant national issue, this study shows that work-related MSDs within hospitals can be a weighty indirect cost.  This research reveals the occupations with the highest incidence (lab animal technicians), highest lost work days (housekeepers), and greatest overall number (inpatient nurses) to assist the ergonomist as to which work groups may be the most important to evaluate in the hospital setting.  Further, the mechanism of injury was nearly evenly distributed between patient handling, lifting/pushing/pulling work equipment, and slips/trips/falls.

Article Title: Surveillance of Musculoskeletal Injuries and Disorders in a Diverse Cohort of Workers at a Tertiary Care Medical Center

Publication: American Journal of Industrial Medicine, 51, 344-356, 2008

Authors: L A Pompeii, H J Lipscomb, and J M Dement

This article originally appeared in The Ergonomics Report™ on 2008-06-04.