Employee Absenteeism in a Southeastern Ontario Tertiary Care Hospital:
A Record Linkage Study
Presenter: Tara L. [email protected]
KFL&A Public Health
Kingston, Ontario, CANADA
Queen’s University Emergency Syndromic Surveillance Team
Outline
RationaleKey MessagesStudy Methods and Analyses Data SourcesResultsDiscussionImplicationsFuture considerations
Queen’s University Emergency Syndromic Surveillance Team
Rationale
Utilization of existing, electronically collected administrative data for the evaluation and surveillance of HCW absenteeismLack of published research on HCW absenteeism regarding infectious disease transmission, and surveillanceThreat of infectious diseases & nosocomial infections (i.e. SARS)
Queen’s University Emergency Syndromic Surveillance Team
Key Messages
Improve OH reportingReducing absenteeism & costsEnhance monitoring of HCW absenteeism
Queen’s University Emergency Syndromic Surveillance Team
Study Methods
Retrospective cohort design involving a record linkage of Occupational Health and Human Resources dataStudy Period – June 1, 2004 to May 31, 2005Study Sample – 1,964 full-time employeesSetting – KGHDescriptive Analysis – rates, frequencies(Multivariate Analysis)
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Data Sources: Occupational Health Data(Injury/ illness reporting)
Parklane Software SystemDate of birth, sex, postal codeDepartmentOH Visit dateSyndrome(s) - pre-determined by the system, classified by Occupational Health nurses
Queen’s University Emergency Syndromic Surveillance Team
Data Sources: Human Resources Data(Absenteeism)
Date of birth, sex, postal codeDepartmentIncident(s), hours, days absent (by month)
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Modified Variables
Independent Variables:DepartmentsFull-time Equivalency
Outcomes:Respiratory Illness - Febrile Respiratory Illness, Upper/ Lower RespiratoryGastrointestinal IllnessMusculoskeletal/ Inflammatory condition
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Objective
To identify and describe absenteeism and Occupational Health visits among full-time Kingston General Hospital (KGH) employees, according to frequency, duration, workplace variables and seasonality.
Queen’s University Emergency Syndromic Surveillance Team
Absenteeism characteristics of Full-time Employees at KGH
Queen’s University Emergency Syndromic Surveillance Team
Primary Reasons for Absenteeism for 3,946 Periods of absence (n=1,964)
10%
12%
22%32%
Respiratory
Gastrointestinal
Musculoskeletal
Undefined/ Other
Neurological/PsychologicalObstetrical/GynaecologyNo reason provided
Absence notreported to OH
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Total number of Absences for Full-time KGH employees reported by HR, but not reported to OH
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Discussion
Highest crude absence rates = Surgical, General Medicine & Paediatric departmentsHighest percentage of visits not reported to OH = General Medicine, Critical Care & Obstetrics/ Gynaecology
**Improve OH Reporting
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Reduced Absenteeism and Costs
Workplace Health PromotionMaximize productivity/ utilization while minimizing staffing costsRetention strategiesTarget specific departments to provide more complete and accurate OH data
= Reduction in costs & Improvement in monitoring
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Next StepsTo examine the potential for integration of this Occupational Health data stream into an existing Emergency Department surveillance system.
Queen’s University Emergency Syndromic Surveillance Team
Emergency Department System
Community Health monitoring systemPublic Health initiativeReal-time - ED visits to 7 area hospitals (KFL&A and HPE Health Units), admissions to 3 hospitalsOutbreak detectionAlerting, Reporting, Dissemination of results
Queen’s University Emergency Syndromic Surveillance Team
Kingston
Belleville
Picton
Napanee
Trenton
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ENN
OX
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& AASTINGSH
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Kingston, Frontenac and Lennox & Addington Public Health
Hastings and Prince EdwardCounties Health Unit
Ottawa
Kingston
Toronto
QUESST rec eives information deta iling Emergency Department visits
QUESST rec eives information deta iling ED visits and Adm issions
ED visits from 7 area hospitals covering 2 public health units
Admissions to 3 hospitals
Approx. 240,000 visits/yr
Population ~ 350,000
System captures ~ 94% of visits by this population
Queen’s University Emergency Syndromic Surveillance Team
Respiratory Illness Reporting
0200400600800
1000120014001600
Jun
'04Ju
l '04
Aug
'04Se
p '04
Oct '0
4No
v '04
Dec '
04Ja
n '05
Feb
'05Ma
r '05
Apr '0
5Ma
y '05
Months
ED visits
020406080100120140160
OH visits
Resp/ ILI EDvisits Reported RespOH visits
Queen’s University Emergency Syndromic Surveillance Team
Gastrointestinal Illness Reporting
050
100150200250300350400450
Jun
'04Ju
l '04
Aug
'04Se
p '04
Oct '
04No
v '04
Dec '
04Ja
n '05
Feb
'05Ma
r '05
Apr '
05Ma
y '05
Months
ED visits
0102030405060708090
OH visits
GI ED visits
Reported GIOH visits
Queen’s University Emergency Syndromic Surveillance Team
Strengths & Limitations
Existing administrative databasesNovel application of health dataAll absenteeism events
Under-reportingSelf-reported outcomesMerge proved difficult
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Implications
Improve OH reportingReduce absenteeism & costs associatedTo create a HCW OH surveillance system
** Monitor HCW injury and illness events
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Future Considerations
Continued monitoring of infectious disease Early detection of hospital-based outbreakIntegration with existing Emergency Department systemPandemic InfluenzaProvide feedback (alerts & reports)
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Thank you
Acknowledgements:Dr. Kieran Moore & Dr. Elizabeth VanDenKerkhofQUESST project for funding and support
Contact Info: [email protected]
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0
10
20
30
40
50
60
70
Surgery GeneralMedicine
Paediatrics
Departments
OH Data
No ReasonRespiratoryMusculoskeletalGastrointestinal
Reasons associated with highest absenteeism by department
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Questions
BTWMF – difficult to interpret, is there information that can be provided?
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Total Absence Reporting
(1.1, 1.8)1.415 + years
(1.1, 1.8)1.45-<15 yearsFull-time Work-years
(1.9, 4.4)2.9Nurses
(1.7, 3.7)2.5Support ServicesUnion Affiliation
95% Confidence
Interval
Adjusted Odds Ratio
Variable
*controlled for union affiliation, annual salary, full-time work-years, sex, age
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Respiratory Illness Reporting
(1.1, 2.0)1.5Female
Sex
(1.2, 2.8)1.8Support Services
Union Affiliation
95% Confidence
Interval
Adjusted Odds Ratio
Variable
*controlled for union affiliation, annual salary, full-time work-years, sex, age
Queen’s University Emergency Syndromic Surveillance Team
Gastrointestinal Illness Reporting
(1.2, 2.2)1.65-<15 yearsFull-time Work-years
(1.6, 4.9)2.8Nursing
(1.2, 3.6)2.1Support ServicesUnion Affiliation
95% Confidence
Interval
Adjusted Odds Ratio
Variable
*controlled for union affiliation, annual salary, full-time work-years, sex, age
Queen’s University Emergency Syndromic Surveillance Team
Conditions
RespiratoryUpper Respiratory - Laryngitis, tonsillitis, sinusitis, tracheitisLower Respiratory - Bronchitis, broncheolitis, pneumoniaFRI symptoms - fever, cough, chills, malaise, body aches
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Conditions
Gastrointestinal IllnessGastroenteritisSymptoms - Nausea, vomiting, diarrhea
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Health Care Worker Absenteeism
When productivity/utilization levels are kept below 80 percent, nurses are more likely to be satisfied with their jobs and absenteeism is reduced. Retention strategies must address:
- physical and mental health of nurses (interpersonal relationships)- balancing the efforts and rewards associated with work- nurse autonomy (job control)- full scope of practice- managerial relationships- innovative work schedules- hiring more nurses into full-time permanent positions- reasonable nurse-to-patient ratios based on targeted productivity/utilization
standards [CHSRF, September 2004]
**Economic Impact
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Last Minute Absence Reasons
Personal illness most common reason for last-minute no-shows (33%)Family issues (24%)Personal needs (21%)Stress (11%)Entitlement mentality (10%)
[CCH Incorporated, 2002 Survey]
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Workplace Health Promotion
Medical costs are directly related to health risks and health behaviours (i.e. employees with fewer risk factors incur lower medical costs).Comprehensive workplace health promotion programs lower health care and insurance costs, decrease absenteeism, and improve performance, productivity and work morale.$1/ $2.05 – $5.96
[Makrides, L., Cdn. Assoc. of Cardiac Rehab., 2004]
Queen’s University Emergency Syndromic Surveillance Team
Reduced AbsenteeismAt DuPont, each dollar invested in workplace health promotion yielded $1.42 in lower absenteeism costs over a 2 year period. [American Journal of Public Health, September 1990]
Johnson and Johnson reduced their absenteeism rate by 15% within two years of introducing their wellness program. They also cut their hospital costs by 34% after just three years. [Human Resources Executive, April 1993]
To prevent back injuries among its employees, a county in California offered classes and fitness training to all it’s workers. As a result, there was a significant decrease in sick days related to back injuries, producing a net cost-benefit ratio of 1 to 1.79. [WELCOA – 1999]
Queen’s University Emergency Syndromic Surveillance Team
Real-time - ED visits to 7 area hospitals (KFL&A and HPE Health Units), admissions to 3 hospitals
Date and Time of Visit or AdmissionHospitalAge/SexPostal Code (5 digits)Chief ComplaintTriage ScoreFebrile Respiratory Illness (FRI) Screening results
Syndromes: Gastroenteritis, Respiratory, Fever/ILI, Asthma, Derm-infectious, Neuro-infectious, Severe Infection, Other
What information are we collecting?