Capturing Work-related Injuries from Emergency Department Data

Work-related injuries frequently occur, despite the fact that many are preventable. It is critical that we accurately describe and monitor these injuries in order to improve prevention efforts.

Because there is no comprehensive data source that captures all work-related injuries, the occupational injury community relies on multiple sources to describe the problem. The occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) is a surveillance system that provides one piece of the picture by capturing nonfatal occupational injuries treated in emergency departments (ED). The National Institute for Occupational Safety and Health (NIOSH) works with the U.S. Consumer Product Safety Commission to capture NEISS-Work data from a national sample of approximately 67 hospital EDs. These data include persons working for pay or compensation, working on a farm, or volunteering for an organized group.

In an effort to better understand the accuracy and process of identifying work-related cases from ED records, NIOSH conducted on-site assessments at 20 hospitals in the NEISS-Work sample. NIOSH staff worked closely with the NEISS-Work coders at each hospital to understand the challenges of identifying work-related cases and capturing the related data.

NIOSH found several factors that facilitated the identification of work-related cases. The presence and use of a work-related indicator (e.g., a checkbox for “injury at work”) in the ED record clearly aided the process. Other indicators of work-relatedness are in various parts of the ED record. Having all parts of the ED record readily available to the NEISS-Work coders improved the chance of identifying cases. Also, coders who regularly interacted with ED staff, whether through formal training or informal conversations, noted that this improved the quality of the work-related information in the ED record.

NEISS-Work case identification criteria often requires a review of the entire ED record. Coders with access to only select parts of the records were limited in their ability to identify work-related cases. Coders also encountered barriers related to incomplete and missing records when attempting to abstract records soon after the ED visit. Needed data was simply unavailable when the ED record did not contain employment information or that information was not updated.

Confusion around the NEISS-Work case criteria at the time of the hospital assessments resulted in some coders relying on a single identifier (e.g., expected payer of workers’ compensation) that did not capture all cases and including cases that were not work-related. It also contributed to coder difficulties identifying unique types of workers, such as students and trainees.

Based on these findings, NIOSH staff revised the guidelines for identifying a work-related injury for NEISS-Work, provided additional training to the NEISS-Work coders, and improved coding documentation used by the NEISS-Work coders in an effort to refine case identification. We anticipate that this will improve the validity of the work-related injury estimates and enable NEISS-Work data to provide more accurate estimates of nonfatal work-related injuries.

Additional details on NEISS-Work as well as a tool that can be used to analyze single years of NEISS-Work data are available at the Work-Related Injury Statistics Query System. For more information on the assessment of NEISS-Work described above, see the poster presented at the 2016 Council of State and Territorial Epidemiologists Annual Conference. This blog is being cross posted on the Council of State and Territorial Epidemiologists website.

If you have worked with ED data in occupational injury research, we are interested in hearing your experiences. Specifically, what challenges have you faced in accurately capturing cases? How did you address those challenges?

Audrey Reichard, MPH, OTR, is an Epidemiologist in the NIOSH Division of Safety Research.
Suzanne Marsh, MPA, is a Health Statistician in the NIOSH Division of Safety Research.
Rebecca Olsavsky, MS, is a Health Communications Specialist Fellow in the NIOSH Center for Motor Vehicle Safety.