Workers' recovery from concussions presenting to the emergency department.

BACKGROUND: The emergency department (ED) is the first point of care for many patients with concussion, and post-concussion syndrome can impact vocational outcomes like successful return to work. Evaluation of concussion in general adult populations is needed. AIMS: To document the occurrence and outcomes of work-related concussion presenting to the ED for treatment. METHODS: This study enrolled adults presenting with concussion to three urban Canadian EDs. Baseline ED interviews, physician questionnaires and patient phone interviews at 30 and 90 days documented work-related events, ED management, discharge advice, patient adherence and symptom severity. Work-related injury and return to work were modelled using logistic or linear regression, as appropriate. RESULTS: Overall, 172 enrolled workers completed at least one follow-up. Work-related concussions were uncommon (n = 28). Most employees (80%) missed at least 1 day of work (median = 7; interquartile range: 3-14). Most (91%) employees returned to work within 90 days, while 41% reported persistent symptoms. Manual labour and self-reported history of attention deficit hyperactivity disorder were associated with work-related concussion, while days of missed work increased with marital status (divorced), history of sleep disorder and physician's advice to avoid work. CONCLUSION: Work-related concussions are infrequent; however, most workers who sustain a concussion will miss work, and many return while still experiencing symptoms. Work-related concussion and days of missed work are mainly affected by non-modifiable factors. Workers, employers and the workers' compensation system should take necessary precautions to ensure that workers return to work safely and successfully following a concussion.

Electronic referrals and data sharing: can it work for health care and social service providers?

The present system for referral of clients, particularly the elderly, to health care and social services providers is often fragmented, slowed by inaccurate or incomplete client information, and therefore less effective and perhaps more costly than it needs to be. A New York demonstration project is currently developing a computer-based information and referral system designed to streamline the referral process, provide client data to multiple agencies with only one admission interview, and offer instant access to selected agency data. Eighteen agencies are involved in the initial 2-year project; others will be invited to join once the system has been refined. Among the issues being addressed as the group creates the Community Information and Referral Access System (CIRAS) are client confidentiality, informed consent, participation guidelines, referral processes, and service definitions.