David Goddard Best Paper Award

Paper: Lumbar spinal fusion surgery outcomes in a cohort of injured workers in the Victorian workers’ compensation system

Author: Dr Janine McMillan

Learning objectives / aims: Lumbar spinal fusion (LSF) outcomes for workers’ compensation patients are worse than for the general population. The objectives were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes.

Methods and findings: This was a retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers’ compensation system. WorkSafe Victoria’s claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses.

Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had substantial work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment.

Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation, and common law or impairment benefit lodgement before surgery.  

Conclusions & implications for practice: An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers’ compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.

Paper: Managing Fatigue Amongst Offshore Workers Through A Digital Solution

Author: Dr Devan Kumarasamy

Learning objectives: This is a sharing of how a practical digital solution is being used to manage fatigue related issues in a large Company whose workers have complex and safety sensitive positions, challenging work schedules and patterns, remote work locations and varied mode of transport to and from work.

Methods and findings: The complexity of the Oil & Gas offshore operations and work, and the difficulty to monitor offshore workers shift schedules, work patterns and movement are mentioned. The various issues and reasons leading to workers fatigue and non-compliance to working hours and shift schedules are discussed.

After a major accident in the industry, the company saw a need to develop standards to curb fatigue among the workers. The steps taken to develop the standards are explained. Even after some years of implementation of the standards, it was found that non-compliance was rampant and could not be controlled. Various reasons are sighted for the non-compliance. A digital solution was developed and an insight into how the system works is provided.

With the development of the digital solution, and pilot implementation, it was found that monitoring could be conducted and compliance had improved. Reasons for non-compliance could be analyzed and addressed appropriately. Implementations issues ranged amongst others, from absence of physical barriers, electrical intrinsicity of the digital device to internet connectivity etc. The various methods of addressing non-compliance are discussed.

Conclusions and implications for practice: The Company is considering the feasibility of implementing the system in all its facilities and work locations, and possibly with other Oil & Gas players in the region. With the adjunct of new technology the Company is planning to enhance the digital system further so that it will work seamlessly and not inconvenience the workers in any way.

Paper: Influencing recovery from work injury from an insurer's perspective

Authors: Dr Chris Colqhuoun FAFOEM, Dr Victoria Oey FAFOEM

Organisation: iCare

Learning objectives: To trial initiatives designed to improve worker and employer experience in the NSW workers compensation system with a view to improve health outcomes for injured workers, including accessing faster treatment and
improving relationships with healthcare providers. These initiatives are led by an internal Medical Office that brings the expertise of qualified medical specialists to the organisation.

Methods and findings: A trial of a Medical Support Panel, where occupational physicians and psychiatrists work within the insurer to review and make recommendations on treatment and/or medical causation proved effective. The Panel have successfully reduced time taken for some decision to be made from six weeks to five days. A pilot program to 'prescribe' social activities for workers who are not yet able to return to work has shown promising results. Long-term the impact of these opportunities for creating and maintaining social relationships will postively influence outcomes by reducing the likelihood of secondary psychosocial conditions developing.

Conclusions and implications for practice: By proactively seeking ways to support injured workers, icare has seen a reduction in timeframes for workers to receive treatment. While it is too early to quantify impacts in return to work and claims costs from these initiatives, early indications are that the desired results are starting to be seen. The embedding of in-house medical knowledge at icare has also increased productive dialogue with healthcare providers and in conjunction with a new streamlined claims model and triaging process all stakeholders, including health professional and workers will see an improvement in how workers compensation claims are handled.

Paper: The impact of sustained hot weather on risk of acute work-related injury in Melbourne, Australia

Author: Professor Malcolm Sim

Learning objectives: The presentation will enhance learning about injury outcomes following extended hot ambient temperatures, a little-known risk in occupational health.

Method & findings: A time-stratified case crossover study design using workers’ compensation claim data examined the association between consecutive days and consecutive nights of hot weather and risk of work-related injury in Melbourne during 2002-2012.  Two and three consecutive days of hot weather was associated with an increased risk of injury. This effect became apparent at 27.6 °C, equivalent to the 70 percentile of maximum temperature distributions for Melbourne during the study period. Exposure to three days of hot weather and the highest temperatures, but not extreme temperatures, was associated with the strongest effect, with a 15% increased risk of injury for workers (OR 1.15, 95% CI 1.01-1.30) exposed to temperatures ≥33.3°C on 3 consecutive days, compared to those who were not. Differences were found for different age groups.

Conclusions & implications for practice: Significant associations between consecutive days of hot weather and risk of work-related injury were apparent at relatively mild temperatures. These findings suggest warnings to minimise harm to workers from hot weather should be given and prevention protocols initiated when consecutive days of temperatures lower than extreme temperatures are forecast.

Paper: Findings of a major mental wellbeing survey - focusing efforts and challenging stereotypes

Author: Anna Snodgrass

Rio Tinto Iron Ore (WA) recognised in 2013 that whilst we had many data sources which document the physical health and safety of our workforce, that there was significantly less data was available to understand the 'full picture' of the mental health of our employees.

Subsequently, in 2014 we established a project to measure the baseline mental wellbeing profile of our employee workforce, in consultation with a Clinical Psychologist and a market and social research company.  The survey was conducted in September 2015, and 2006 employees volunteered to participate.  

The survey has resulted in a number of major benefits including:

• the ability to make more informed decisions regarding mental wellbeing priorities, and resource allocation, based on quantitative evidence; 
• an excellent engagement process with our employees which has challenged the stigma surrounding poor mental health by making it 'okay to talk about whether you are okay' at work, and 
• the ability to challenge some common stereotypes in the mining industry e.g. if you are FIFO, you are at greater risk of poor mental health.

We feel that there are useful learnings from this survey that may be adopted more broadly across other employment sectors when considering the mental wellbeing of the workforce.