The direct cost burden of 13years of disabling workplace injuries in the U.S. (1998-2010): Findings from the Liberty Mutual Workplace Safety Index.

INTRODUCTION: Although occupational injuries are among the leading causes of death and disability around the world, the burden due to occupational injuries has historically been under-recognized, obscuring the need to address a major public health problem. METHODS: We established the Liberty Mutual Workplace Safety Index (LMWSI) to provide a reliable annual metric of the leading causes of the most serious workplace injuries in the United States based on direct workers compensation (WC) costs. RESULTS: More than $600 billion in direct WC costs were spent on the most disabling compensable non-fatal injuries and illnesses in the United States from 1998 to 2010. The burden in 2010 remained similar to the burden in 1998 in real terms. The categories of overexertion ($13.6B, 2010) and fall on same level ($8.6B, 2010) were consistently ranked 1st and 2nd. PRACTICAL APPLICATION: The LMWSI was created to establish the relative burdens of events leading to work-related injury so they could be better recognized and prioritized. Such a ranking might be used to develop research goals and interventions to reduce the burden of workplace injury in the United States.

Internet and telephonic IVR mixed-mode survey for longitudinal studies: choice, retention, and data equivalency.

PURPOSE: This study examined data equivalency and loss to follow-up rates from Internet and interactive voice response (IVR) system surveys in a prospective-cohort study. METHODS: 475 limited-service restaurant workers participating in the 12-week study were given a choice to report their weekly slipping experience by either IVR or Internet. Demographic differences, loss to follow-up, self-reported rates of slipping, and selection of first and last choices were compared. RESULTS: Loss to follow-up rates were slightly higher for those choosing the IVR mode. Rates of slipping and selection of first and last choices were not significantly different between survey modes. Propensity to choose an Internet survey decreased with increasing age, and was the lowest among Spanish speakers (5%) and those with less than a high school education (14%). CONCLUSIONS: Studies relying solely on Internet-based data collection may lead to selective exclusion of certain populations. Findings suggest that Internet and IVR may be combined as survey modalities within longitudinal studies.

A comparison of workplace safety perceptions among financial decision-makers of medium- vs. large-size companies.

This study, through a random national survey in the U.S., explored how corporate financial decision-makers perceive important workplace safety issues as a function of the size of the company for which they worked (medium- vs. large-size companies). Telephone surveys were conducted with 404 U.S. corporate financial decision-makers: 203 from medium-size companies and 201 from large companies. Results showed that the patterns of responding for participants from medium- and large-size companies were somewhat similar. The top-rated safety priorities in resource allocation reported by participants from both groups were overexertion, repetitive motion, and bodily reaction. They believed that there were direct and indirect costs associated with workplace injuries and for every dollar spent improving workplace safety, more than four dollars would be returned. They perceived the top benefits of an effective safety program to be predominately financial in nature - increased productivity and reduced costs - and the safety modification participants mentioned most often was to have more/better safety-focused training. However, more participants from large- than medium-size companies reported that "falling on the same level" was the major cause of workers' compensation loss, which is in line with industry loss data. Participants from large companies were more likely to see their safety programs as better than those of other companies in their industries, and those of medium-size companies were more likely to mention that there were no improvements needed for their companies.

Corporate financial decision makers' perceptions of their company's safety performance, programs and personnel: Do company size and industry injury risk matter?

OBJECTIVE: Top-level managers make important decisions about safety-related issues, yet little research has been done involving these individuals. The current study explored corporate financial decisions makers' perceptions of their company's safety and their justifications for these perceptions. This study also explored whether their perceptions and justifications varied as a function of company size or industry injury risk. PARTICIPANTS: A total of 404 individuals who were the most senior managers responsible for making decisions about property and casualty risk at their companies participated in this study. METHODS: The participants took part in a telephone survey. RESULTS: The results suggest that corporate financial decision makers have positive views of safety at their companies relative to safety at other companies within their industries. Further, many believe their company's safety is influenced by the attention/emphasis placed on safety and the selection and training of safety personnel. Participants' perceptions varied somewhat based on the size of their company and the level of injury risk in their industry. CONCLUSIONS: While definitive conclusions about corporate financial decision makers' perceptions of safety cannot be reached as a result of this single study, this work does lay groundwork for future research aimed at better understanding the perceptions top-level managers.

Etiology of work-related electrical injuries: a narrative analysis of workers' compensation claims.

The purpose of this study was to provide new insight into the etiology of primarily nonfatal, work-related electrical injuries. We developed a multistage, case-selection algorithm to identify electrical-related injuries from workers' compensation claims and a customized coding taxonomy to identify pre-injury circumstances. Workers' compensation claims routinely collected over a 1-year period from a large U.S. insurance provider were used to identify electrical-related injuries using an algorithm that evaluated: coded injury cause information, nature of injury, "accident" description, and injury description narratives. Concurrently, a customized coding taxonomy for these narratives was developed to abstract the activity, source, initiating process, mechanism, vector, and voltage. Among the 586,567 reported claims during 2002, electrical-related injuries accounted for 1283 (0.22%) of nonfatal claims and 15 fatalities (1.2% of electrical). Most (72.3%) were male, average age of 36, working in services (33.4%), manufacturing (24.7%), retail trade (17.3%), and construction (7.2%). Body part(s) injured most often were the hands, fingers, or wrist (34.9%); multiple body parts/systems (25.0%); lower/upper arm; elbow; shoulder, and upper extremities (19.2%). The leading activities were conducting manual tasks (55.1%); working with machinery, appliances, or equipment; working with electrical wire; and operating powered or nonpowered hand tools. Primary injury sources were appliances and office equipment (24.4%); wires, cables/cords (18.0%); machines and other equipment (11.8%); fixtures, bulbs, and switches (10.4%); and lightning (4.3%). No vector was identified in 85% of cases. and the work process was initiated by others in less than 1% of cases. Injury narratives provide valuable information to overcome some of the limitations of precoded data, more specially for identifying additional injury cases and in supplementing traditional epidemiologic data for further understanding the etiology of work-related electrical injuries that may lead to further prevention opportunities.

Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees.

In 2007, the Bureau of Labor Statistics reported that the incidence rate of lost workday injuries from slips, trips and falls (STFs) on the same level in hospitals was 35.2 per 10,000 full-time equivalents (FTE), which was 75% greater than the average rate for all other private industries combined (20.2 per 10,000 FTEs). The objectives of this 10-year (1996-2005) longitudinal study were to: 1) describe occupational STF injury events in hospitals; 2) evaluate the effectiveness of a comprehensive programme for reducing STF incidents among hospital employees. The comprehensive prevention programme included analysis of injury records to identify common causes of STFs, on-site hazard assessments, changes to housekeeping procedures and products, introduction of STF preventive products and procedures, general awareness campaigns, programmes for external ice and snow removal, flooring changes and slip-resistant footwear for certain employee subgroups. The hospitals' total STF workers' compensation claims rate declined by 58% from the pre-intervention (1996-1999) rate of 1.66 claims per 100 FTE to the post-intervention (2003-2005) time period rate of 0.76 claims per 100 FTE (adjusted rate ratio = 0.42, 95% CI: 0.33-0.54). STFs due to liquid contamination (water, fluid, slippery, greasy and slick spots) were the most common cause (24%) of STF claims for the entire study period 1996-2005. Food services, transport/emergency medical service and housekeeping staff were at highest risk of a STF claim in the hospital environment. Nursing and office administrative staff generated the largest numbers of STF claims. STF injury events in hospitals have a myriad of causes and the work conditions in hospitals are diverse. This research provides evidence that implementation of a broad-scale prevention programme can significantly reduce STF injury claims.

Corporate financial decision-makers' perceptions of workplace safety.

This study, through a random national survey, explored how senior financial executives or managers (those who determined high-level budget, resource allocation, and corporate priorities) of medium-to-large companies perceive important workplace safety issues. The three top-rated safety priorities in resource allocation reported by the participants (overexertion, repetitive motion, and bodily reaction) were consistent with the top three perceived causes of workers' compensation losses. The greatest single safety concerns reported were overexertion, repetitive motion, highway accidents, falling on the same level and bodily reaction. A majority of participants believed that the indirect costs associated with workplace injury were higher than the direct costs. Our participants believed that money spent improving workplace safety would have significant returns. The perceived top benefits of an effective workplace safety program were increased productivity, reduced cost, retention, and increased satisfaction among employees. The perceived most important safety modification was safety training. The top reasons senior financial executives gave for believing their safety programs were better than those at other companies were that their companies paid more attention to and emphasized safety, they had better classes and training focused on safety, and they had teams/individuals focused specifically on safety.

Work-related ladder fall fractures: identification and diagnosis validation using narrative text.

OBJECTIVE: To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries. METHODS: Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios. RESULTS: Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures. CONCLUSIONS: Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.

Disabling occupational injury in the US construction industry, 1996.

In 1996 the US construction industry comprised 5.4% of the annual US employment but accounted for 7.8% of nonfatal occupational injuries and illness and 9.7% of cases involving at least a day away from work. Information in the published literature on the disability arising from construction injuries is limited. The construction claims experience (n = 35,790) of a large workers' compensation insurer with national coverage was examined. The leading types and sources of disabling occupational morbidity in 1996 in the US construction industry were identified. Disability duration was calculated from indemnity payments data using previously published methods. The average disability duration for an injured construction worker was 46 days with a median of 0 days. The most frequently occurring conditions were low back pain (14.8%), foreign body eye injuries (8.5%), and finger lacerations (4.8%). Back pain also accounted for the greatest percentage of construction claim costs (21.3%) and disability days (25.5%). However, the conditions with the longest disability durations were sudden-onset injuries, including fractures of the ankle (median = 55 days), foot (42 days), and wrist (38 days). Same-level and elevated falls were the principal exposures for fractures of the wrist and ankle, whereas elevated falls and struck by incidents accounted for the majority of foot fractures. Manual materials handling activities were most often associated with low back pain disability. The results suggest that these most disabling injuries can be addressed by increasing primary prevention resources in slips and falls and exposures related to injuries of sudden-onset as well as in reducing manual materials handling and other exposures associated with more gradual-onset injuries.