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Occupational Health in the UC

Andy Barnett, MD and Matthieu DeClerck, MD
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Urgent Care’s are well suited to provide care to patients presenting with work related injuries. The delivery of care for these patients does not differ in terms of diagnosis, examination, and treatment for such injuries. No specific accreditation is required to care for this patient population, but an understanding of how to properly chart the patient encounter for these patients is essential to improving the quality and work flow of the care provided for these patients

Pearls:

  • UC providers should feel comfortable evaluating patients for work related injury because UC is very often where patients with minor work related injuries will seek care initially.

  • The approach to evaluation of a patient with any given complaint should be the same whether or not the complaint is work related.

  • Thorough documentation is critical for work related claims because the documentation will be used to determine whether the patient’s injury is covered by workman’s comp insurance. 

  • Most patients presenting to UC with work related injury should be allowed to return to work immediately with a note documenting common sense restrictions in plain english.

  • Follow-up for work related injury should occur sooner than would be recommended for similar issues when non-work related. 

 

  • Occupational health is a wide ranging medical specialty focusing on reducing harm in the workplace. 

    • Evaluation and management of work related injuries actually comprises only a small portion of occupational medicine.

  • Work related illness and injury specifically refers to a condition that arises or is exacerbated by an event or exposure while on the job.

  • Urgent care centers  commonly offer occupational health services because it provides reliable patient volume, which is of particular value especially during non-cold and flu season. 

  • The role of the UC provider in dealing with claims of workplace injury is not to adjudicate whether the issue  is work related, but rather, to evaluate and treat the patient for their complaint and document the history and objective findings.

    • E.g. In the case of a patient with an exacerbation of chronic back pain. The UC provider should evaluate for conditions needing specific intervention (such as radiculopathy, cauda equina etc.) and treat the patient’s acute pain as they would any other patient with mechanical back pain. 

    • Inquiring about prior history of related conditions and documenting this will be helpful for the ultimate determination of whether the claim being work related is justified. 

  • Patients who present with a work related injury will generally require documentation of any activity restrictions they should abide for their employer when they are discharged. 

  • Meticulous documentation in these for work related injury is crucial, especially in cases where there are restrictions and/or pre-existing conditions, because the UC provider’s chart will be used to determine causality.  The causality of the injury, in turn, will determine the employers financial responsibility for the patient/employee’s ongoing care.

    • Thorough charting minimizes the likelihood of being deposed to answer further questions later if there is a dispute about causality.

    • Being deposed for work related injury should not be a source of worry. If lawyers are contacting you, it is not over an issue of liability in most cases. 

    • If you are deposed in a workman’s comp case, you are not obligated to voice an opinion about causality and can simply say, “I don’t know.” 

  • Most patients who present to UC for work related injury will have a relatively minor issue which will allow them to return to work immediately with some restrictions. 

    • Simple clinical judgement and common sense is sufficient for determining restrictions.

    • Many activity restriction forms will have an impractically large number of checkboxes. Rather than completing this part of the form, it is acceptable and more reasonable to briefly write in the comments section what the patient specifically cannot do. 

      • E.g. “Can’t use left hand.”  “Can’t stand for more than 10 minutes at a time.” 

      • Based on the restrictions, the employer will then determine how the patient will function in the workplace until they have recovered full function.

  • Follow-up is an important consideration for work related injury and must also be charted well.

    • Follow-up should be scheduled sooner than would be typical for a similar complaint that is non-work related because their functional status will often have significant financial implications for both themselves and their employer

      • Typically, initial follow-up visits should be recommended within one week. 

  • The initial assessment of a work related injury can be done by any provider, however, workman’s compensation payors will often have a network of approved providers who can manage follow-up care. 

References:

Lebow M. “Foundation of Occupational Medicine in the Urgent Care Setting,” Journal of Urgent Care Medicine, https://www.jucm.com/foundation-occupational-medicine-urgent-care-setting/.

Sangduan B. -

Thank you for talking about Occupational Health in the UC.

Mike W., MD -

our pleasure!!
M

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Urgent Care RAP - January 2020 Written Summary 2 MB - PDF

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