On any given day, school nurses have a lot on their plate as they deal with student injuries and illnesses, including the unique care of special needs students. Because they are the on-site campus medical professionals, school nurses are sometimes required to take care of employee work injury cases. This is not optimal because a work injury is a medical-legal event that may entail assessment and expertise beyond the scope of practice and personal clinical competence of the school health professional. The addition of a Workers’ Compensation Nurse Triage Hotline facilitates a healthy relationship between school nurse and triage nurse that helps alleviate concerns that come along with unfamiliar territory while increasing efficiency in reporting and substantially reducing workers’ compensation costs.
The collaboration between the on-site school nurse and the remote triage nurses makes it possible to get a clearer assessment to better guide the employee’s injury. For example, Dorothy, an Injury Hotline Nurse, was fortunate to have a nurse present when Cynthia, an injured school instructor, called reporting an injury to her knee. It was clear that Cynthia was emotionally distressed as a result of her visible injury and pain, describing her knee as “dislocated.” However, when Dorothy asked for the school nurse’s assessment, it was more of a severe swelling to the knee which reinforced Dorothy’s decision to send Cynthia to an Urgent Care facility. The addition of a set of professional eyes, on-site, facilitated the best course of action for the employee’s care and eliminated a costly ER visit.
With the 24/7 workers’ injury hotline in place, school nurses and support staff are freed-up from the claims process. The comprehensive and instantaneous reporting provided to all stake holders (District, Claims, Clinic/ER, and HR/Risk Management) by the hotline allows school staff to focus more closely on the diverse needs of the students. As a result of a more efficient reporting process, it is possible for employers to perform more timely internal investigations and revise procedures which aid in future injury prevention. For example, a health assistant at a public school attended a training session that required a demonstration on how to use an EpiPen. Thinking that the training device didn’t contain any medicine, an employee volunteered to demonstrate how to administer the EpiPen on herself. Unfortunately, the “Trainer” contained an expired dose of medicine. Since the school’s employee reported the incident immediately to Company Nurse, all the stakeholders were notified about the incident within minutes, allowing them to make revisions to their safety protocols for future trainings.
Often, the care required for a work injury is as simple as first aid. However, unless the on-site health professional is immediately available and experienced in work injury claims, these injuries might result in a costly ER visit. With a worker’s injury hotline in place, ultimately, 35 – 42% of work injuries reported by school employees do not result in a claim. The key issue is that employees feel safe and supported by a medical professional that is easily accessible and well-versed in helping to determine the appropriate level of care. Not only are work injury hotline nurses qualified to provide this service to injured school employees 24/7, but they can also be a valuable asset and calming force for the school nurse in assessing an injury and relieving anxieties brought on by the claims process. The professional eyes of the school nurse, in concert with the work injury expertise of Company Nurse’s RNs, result in notable savings for school districts and increased employee satisfaction.
Employers-looking for new and innovative solutions to traditional workers’ compensation challenges-have begun to leverage nurse triage hotlines, which essentially enable a more proactive and compassionate response to employee worksite injuries.
These nurse hotlines provide valuable injury management services, which include timely reporting of injuries; a nurse’s medical expertise to assess injuries and triage them to the best, most appropriate level of care; and coordination of a safe and prompt return-to-work (RTW) result.
When properly coordinated with other managed care strategies, nurse call centers dramatically improve workers’ compensation costs and outcomes for employers, and enhance medical care and satisfaction for employees. In this white paper, we outline the key benefits, savings, and considerations in implementing these programs.
Timely, Accurate Reporting of Injuries
Although it’s well understood that prompt reporting of injuries leads to improved claims outcomes, there are still many barriers to achieving this best practice. The first obstacle is simple compliance. Many employees may not report injuries until they become worse or require serious medical attention. In some cases, supervisors who have a full plate of responsibilities may be delayed in submitting required paperwork.
With a nurse triage hotline, an injured worker or supervisor simply calls a toll-free number immediately following the incident. With this hassle-free procedure, the lag time in reporting injuries is significantly reduced. The call center gathers all the necessary injury and claims information and fills out required forms. It then sends the first report of injury via email or fax to all the appropriate stakeholders, including the employer, physician, claims adjuster, and RTW coordinator. Immediate dissemination of injury information allows each stakeholder to initiate their respective roles in the workers’ compensation process, supporting optimal outcomes.
Nurse Triage Ensures Appropriate Care
Beyond timely reporting, another key challenge in workers’ compensation is ensuring that every injury receives the care and treatment appropriate to its level of medical severity. Although employers may train supervisors on how to respond to worksite injuries, these managers are not medical professionals and should not be expected to make treatment decisions. Many err on the side of caution, sending employees with even minor injuries to the emergency room.
To address these challenges, a nurse at the call center provides an objective medical assessment of the injury and channels the employee to the most appropriate, cost-effective level of care. In severe cases, a nurse will advise emergency care. With minor injuries, however, the nurse may provide simple first aid or self-care guidelines, or send the patient to an occupational clinic in the employer’s preferred provider network.
After speaking with a nurse, many injured employees do not require or request additional medical services. As a result, 20 to 40 percent of all calls become “report only” or “first aid” injuries and do not result in compensable claims. For many employers, this has led to a 20 to 30 percent reduction in claims costs.
Optimal RTW Results
Nurse hotlines should also offer an online database, in which employers can house detailed job descriptions and transitional work assignments for all essential positions in various departments. With this information, employers stand ready to respond on the day of injury and are able to match modified duty assignments to employee work restrictions. As a result, many employees are able to return to work immediately, reducing lost time by as much as 50 percent.
Employee Care and Satisfaction
In the end, nurse hotlines benefit employees most of all. Triage nurses are highly compassionate medical professionals, who listen closely to the details of each injury and provide personalized attention to each employee, focusing on unique medical needs. As a result, employees have an overwhelming positive experience. Employers that provide this type of service send a clear message to their staff-that they care about employee health, safety, and recovery. /span>
Key Hotline Considerations
Employers may hesitate to utilize a nurse hotline, believing a call center may not be able to accommodate unique policies or procedures. However, sophisticated hotlines allow for a high level of flexibility. The injury reporting and triage process can be customized to support employer-specific requirements, whether it’s including certain providers into the referral process or customizing the injury information that is collected.
Another perceived issue is being forced to manually re-input injury information into claims systems. Hotlines have addressed this issue as well, designing real-time interfaces that electronically transmit data into popular software.
At first, supervisors may view call centers as an additional step in process and initially resist adoption of an injury hotline program. Once employers enroll, however, a program representative will train staff on how to fully leverage the program, and provide promotional material, such as posters and wallet cards, to remind staff to utilize the toll-free hotline to report injuries. Supervisors quickly realize the program actually relieves them of the burden of having to make medical decisions on where to send an employee for care, as well as decreases their workload by reducing paperwork and forms.
Paul Binsfeld is the CEO of Company Nurse, a firm specializing in medical triage and injury management for workers’ compensation. Binsfeld has over 20 years of experience in the workers’ compensation industry. By working with many different types of employers, he identified a common need for early intervention in the workers’ compensation claims and injury management process. As a result, Binsfeld developed a nurse injury hotline to address many of today’s workers’ compensation challenges.
For more information, email email@example.com or go to www.companynurse.com.
The role of a supervisor often involves wearing many hats including handling employee workplace injuries. Though many supervisors receive training in how to respond to worksite injuries, they do not have the medical expertise required to provide the most appropriate recommendations for medical treatment. Therefore, this response often involves a guessing game. Is an ER visit really the most appropriate course of action? Should the employee wait until symptoms get worse to seek medical treatment?
Supervisor Makes the Right Call
Robert, an electrician for a municipal utilities company, was working at a client’s property when he noticed an issue with the transformer. As he attempted to service the transformer, there was a loud explosion and bright flash. Robert had no visible injuries but experienced ringing in his right ear and loss of hearing in his left ear. Following company protocols, the substitute supervisor called Company Nurse’s Triage Hotline to report the incident and seek care advice for Robert’s potential injuries. The substitute supervisor expressed unfamiliarity with the process but emphasized that he wanted to see if there was anything that could be done “now instead of later.” His primary concern was that Robert might have an eye injury that he called a “welder’s flash burn” resulting from close exposure to the bright flash that occurred during the explosion.
As triage nurse Dorothy familiarized herself with the incident and Robert’s symptoms, she determined that he required immediate medical attention for his ears. With her medical training and experience she knew that sudden loss of hearing and ringing in the ears can be signs of serious damage to the eardrum. Concerned for Robert’s health and wellness, Dorothy noted that there was a small window of time to effectively treat this type of injury. She referred Robert to the employer’s designated medical facility and assured both the supervisor and Robert that she would also note on his report the concern for eye injury. This was a simple solution that probably mitigated and possibly avoided a significant exposure for the employer.
Right Care at Right Time
The triage nurse was able to alleviate supervisor’s concerns about making a medical treatment decision. In many work environments, supervisors don’t want to be involved in deciding when and where an employee should be sent for medical care. In this specific incident, the substitute supervisor was not familiar with the claims process and company protocols. Like most supervisors, he wanted to do what was best for the injured employee and company, but he did not realize Robert’s ears required immediate medical attention.
It is common for supervisors to err on the side of caution and refer injured workers to the ER when it is sometimes unnecessary. On the contrary, some supervisors may advise injured workers to wait and see if symptoms arise before directing them to an occupational health clinic. In doing so, they potentially miss the urgent window of time necessary for the injury to be treated effectively. Luckily, in Robert’s case, his supervisor took a proactive approach and sought professional medical advice for his employee sooner rather than later.
There is a window of opportunity immediately following a workplace injury to better address the employee’s course of medical treatment. Directing employees to appropriate, cost-effective care is a key component in successful medical demand management. By leveraging a nurse triage hotline on the day of injury, employers can not only eliminate the guessing game by making sure employees are referred to the appropriate medical care, but also prevent unnecessary medical costs and legal fees.
Susan, a teacher’s aide employed by a California School District, was supervising recess on the school playground when a student accidentally collided with her. As a result, she suffered trauma to the left side of her head. Following her employer’s protocol, she called Company Nurse Injury Hotline to report the incident complaining of a bump and headache. On this day, Helen, an Injury Care Coordinator, responded to Susan’s call. As she listened and asked questions, Helen realized that Susan didn’t understand the urgency and potential risks involved with head injuries; she simply wanted to report the incident and seek care later. Confident with her experience and knowledge, Helen convinced Susan that speaking with a triage nurse was imperative and that it would not be a long process. As a result, Susan spoke with a nurse and was referred to care on the day of injury.
Early Intervention Builds Confidence
This story is notable because it reveals how effective early intervention can instill confidence in an injured employee that they are being led on the right path. Unnecessary obstacles and frustration often come along with these incidents when they are not handled appropriately. For example, Susan did not realize the potential of her head injury being much more serious than she considered it to be, and that seeking the advice of qualified professionals could save her from further medical complications. She was more focused on her professional obligations and time constraints than on taking the appropriate measures for her injury. With compassion and understanding, Helen responded to her unique situation, relating to Susan not only as a professional but also as an injured person in need of care.
To the benefit of the organization, implementation of professionals at the front end of a claim relieves the employer and supervisors of guessing what the appropriate level of care might be for the injured worker. This early intervention and medical advice could eliminate unexpected medical costs down the road. A study run by Workers Compensation Research Institute, WCRI, showed that “cases with significant and moderate surprises represented about 30 percent to 40 percent of medical costs in most states”. The same study revealed that some states surpassed this average, such as California where these cases represented 57 percent of medical costs. If an injury is addressed the day it occurs, the possibility of cases resulting in the accrual of unnecessary medical costs decreases dramatically. There is confidence in the process and reassurance in knowing that the injury will be handled in a cost-effective manner that is beneficial to the well-being of the employee.
The Power of Knowledgeable Early Intervention Paves the Way for Effective Cost Management and Employee Satisfaction
As Helen demonstrated, one of the most important components of early intervention is to listen carefully to the nature of each injury and focus on the employee’s unique medical needs. This enabled her to provide an immediate and compassionate response that quite possibly prevented future complications with Susan’s health. At the same time, Susan’s employer was able to avoid potential medical costs. Balancing the business needs of organizations with the well-being of their workers is the ultimate goal of a nurse triage injury hotline; it is the power of knowledgeable early intervention that paves the way for effective cost management and employee satisfaction.
“W.C. Cases with Significant Unanticipated Medical Care and Costs Reviewed in New WCRI Study of Adverse Surprises”.
WCRI Media Releases. June 30, 2005. Web. May 21, 2011. http://www.wcrinet.org/media_release_adverse_surprises.html.
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