By: Tammy Bradly, VP Clinical Product Development, Coventry Workers’ Comp Services
How confident would you feel about reaching a destination without knowing which route to take, what roadblocks you might encounter or what awaits you when you get there? Would you remember directions someone may have given you at a time when you didn’t need them? Or would you feel unsure and perhaps even a little resentful that you needed to make the journey, much less without guidance?
So you can imagine how an employee might feel in the aftermath of a work injury if they don’t know how to report an injury (or misplaced the instructions), don’t know where to seek treatment or don’t know what the employer’s return-to-work policy entails. Fortunately, it is possible to drive better outcomes by providing a professional guide at the time of injury. A nurse triage program can help injured employees navigate the system and make informed decisions allowing them to choose the right level of care for their specific injury. At the same time, it shows the employee that the employer cares about his or her wellbeing. This can strengthen the employer/employee relationship and have a positive impact on outcomes.
The importance of a roadmap
The Workers Compensation Research Institute has identified trust in the work relationship as a critical variable in predicting RTW outcomes.1 At a vulnerable time, injured employees need to be able to trust that their employer is doing right by them and that means extending trust to others, including the treating providers and insurance company or third-party administrator. If that trust doesn’t exist at the outset, the injured worker can easily veer off course. One way that employers can earn trust at the time of injury is to give employees ready access to a trusted source of credible information—a nurse. Year after year, polls by the Gallup® Organization find that Americans trust nurses more than any other profession—even more than doctors or pharmacists.2 That makes nurses the ideal professionals to establish a roadmap for success in a workers’ comp case.
Without access to this trusted resource, the injured employee often has to rely on a front-line supervisor to know what to do—i.e., whether to call 911 or tell him or her to go to the emergency room or an urgent care clinic. In some cases, the injured employee will see his or her own personal physician. After hours or on weekends, employees may have to choose a provider themselves. The consequences of such scenarios can be over- or under-treatment, employees who don’t trust—and therefore don’t follow—the treatment plan, and an employer/employee relationship that may be on shaky ground.
In comparison, a nurse triage program can offer a number of advantages by making sure that the injured worker receives clinically sound treatment recommendations. Under such a program, after an injury occurs, the first step is to place a call to a hotline staffed around the clock by registered nurses who can assess the situation. Depending on employee demographics, it can be useful to have access to bilingual nurses on staff and/or interpreters for non-English-speaking callers, as well as access to relay services for employees with hearing impairments, as part of the standard service. The employee speaks directly to the nurse, and the call is confidential.
Armed with clinical knowledge and evidence-based triage guidelines, the nurse can help the injured employee make an informed decision about the most appropriate level of care or care setting. If the situation is urgent, the nurse may direct the employee to proceed to the nearest emergency room. In non-emergency situations, he/she can recommend a plan of action. Depending on the nature of the injury, options might range from simple first-aid directions or self-care to being seen by a provider. In a surprising number of cases, self-care may be the most appropriate choice. According to the American Institute for Preventive Medicine, 25 percent of physician visits and 55 percent of emergency room visits are unnecessary.3 And, nurse triage programs used in workers’ comp have demonstrated that nearly half of the callers are likely to opt for self-care rather than seeking out medical care in an emergency room or with a physician.
If the employee chooses self-care, the nurse can provide specific instructions. Or, if necessary (and jurisdictionally permitted), she can refer the injured employee to a treating provider in the employer’s network. Ideally, the nurse should be able to recommend a provider with experience in workers’ compensation and a record of positive return to work outcomes. (Look for more on the topic of outcomes-based networks next week.)
Beat a path toward improved outcomes
Nurse triage at the time of injury can go a long way toward building trust and setting things in a positive direction, often preventing the incident from becoming an actual claim. The triage nurse can also follow-up to monitor any change in the employee’s condition. This can be particularly useful when an injured employee has chosen self-care. Employers who want to develop that trust further by extending care beyond nurse triage could also engage a case manager, who can coordinate with the treating provider and follow up on return-to-work plans.
It’s surprising that more employers haven’t utilized nurse triage for workers’ comp when those who have implemented such programs have seen significant decreases in the number of medical and indemnity claims and in workers’ comp-related medical costs. Even more important, by providing access to a nurse at a critical point in the process, these employers have demonstrated that they want their injured employees to receive timely and appropriate care. In essence, they are giving their employees a clear roadmap to help point them toward a desirable outcome for all involved.
About Tammy Bradly
Tammy Bradly is vice president of clinical product development for Coventry Workers’ Comp Services. Bradly is a certified case manager with more than 25 years of comprehensive industry experience through service delivery, operations management and product development. She holds several national certifications, including certified case manager (CCM), certified rehabilitation counselor (CRC) and certified program disability manager (CPDM).
About Coventry Workers’ Comp Services
Coventry offers workers’ compensation cost and care management solutions for employers, insurance carriers and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 30 years of industry experience, knowledge and data analytics. The company offers an integrated suite of solutions, powered by technology to enhance network development, clinical integration and operational efficiencies at the client desktop, with a focus on total claims cost.
1Robinson, Thomas. WCRI Identifies Trust in the Workplace as a Key “Predictor” of Outcomes Important to Injured Workers. LexisNexis Workers’ Compensation eNewsletter, 2014. Retrieved September 16, 2014, from http://www.lexisnexis.com/legalnewsroom/workers-compensation/b/recent-cases-news-trends-developments/archive/2014/07/06/wcri-identifies-trust-in-the-workplace-as-a-key-predictor-of-outcomes-important-to-injured-workers.aspx.
2Gallup® poll. Honesty/Ethics in Professions. Dec. 5–8, 2013. Retrieved July 29, 2014 from http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx.
3American Institute for Preventive Care. Medical Self Care Savings. 2011. Retrieved Jan. 18, 2015 from http://www.healthylife.com/documents/2011_Medical_Self-Care_Savings_White_Paper.pdf
Coventry WCS is a WorkCompWire Ad Partner.
This is not a paid placement.