An early intervention program for hospital workers at high risk of delayed injury recovery has revealed fewer lost work days over a two-year period and substantial cost reductions when compared with the usual, so-called ‘stepped care’.

The findings stem from the research undertaken by University of Sydney researchers, personal injury claims management organisation EML and NSW Health. The Work Injury Screen and Early Intervention, or WISE program, has been so successful that it’s now been adopted by all NSW public hospitals.

The findings were recently published in the Journal of Occupational Rehabilitation.

EML invests heavily in outcome driven research to benefit our customers,” EML Member Benefits Manager Elisa Hitchens said.

“To be a part of a research effort immediately implemented by NSW Health is an excellent outcome.

“EML is now working on other research programs to better support injured workers, their employers.”

What is WISE?

The WISE protocol was a co-ordinated approach to injured hospital workers identified as at a high risk of delayed recovery by a brief psychosocial screening. The coordinated intervention targeted both psychological and workplace risk factors.

“Injured workers with soft tissue (musculoskeletal) injuries, the most common work-related injuries, who had taken medically-sanctioned time off work were screened for psychosocial and disability risk factors within the first one to three weeks of injury,” University of Sydney Professor Michael Nicholas said.

“This was regardless of progress in initial treatment.

“An intervention plan was also immediately implemented which included early confirmation of diagnosis and active treatment for the injured worker, supported by the workplace.”

By contrast, the existing state-wide guidelines for injured workers follows a stepped-care model. Psychological and social risk factors are considered only after a poor response to initial treatment (6–8 weeks, or longer, after the injury).

This is a pivotal time for recovery when we want to make sure that the right support is in place at the right time,” Elisa Hitchens said.

“We’ve found that the length of absence from the workplace, colleagues and active living is associated with increased risk of prolonged absence from work, longer term ill health and associated financial insecurity, family issues and costs to the community.”

The premise

The research was based on studies indicating that psychological and social/environmental factors are strong predictors of delayed recovery and disability associated with chronic pain. As many of these psychosocial risk factors (e.g. anxiety, depression, catastrophising, poor workplace support) are modifiable, interventions targeting them could prevent long-term disability. This relates only to injured workers with psychological risk factors.

The process

The EML Case managers (CMs) were split into two teams, independent of each other and working with either the WISE program hospitals or the usual stepped care hospitals. Data on work status, lost days and costs was gathered, as usual, for a minimum of two years by EML.

The screening was undertaken over the phone by the worker’s EML Case Manager with the customer offered up to six sessions with a psychologist who had been briefed on the project. Their NSW Health Recovery at Work Adviser and Case Manager worked together with their treating team to support recovery.

At the 12-month mark all participants were telephoned by an independent research assistant, blind to the group status of each worker, to answer questions on their current work and pain status, treatment and RTW experiences.

The findings

At the end of the two-year post-injury period the mean lost work days for the usual-care program was 66.5 days. The WISE program was 31.7, less than half.

There was:

  • Little difference in costs for the first ten to 11 months
  • After ten to 11 month the WISE program participants’ costs plateaued
  • Costs for those treated as usual, increased
  • The WISE program showed a saving of just under $7,000, or a 30% difference per case
  • The stepped program costs continued to rise over time
  • Fewer WISE program workers reported ongoing (chronic) pain
  • WISE program workers reported a higher satisfaction with the Case Manager

Originally, it was intended to include a five-year follow-up. But after seeing the results the funding bodies, including the employer, decided to stop the trial after two years. They felt the outcomes were clear and wanted to implement the WISE protocol across all public hospitals across the state. This was done over the following year (2016) with the help of the Research Manager. This decision is considered a key goal in occupational injury research.

This outcome also provides support for the:

  • theoretical framework regarding the implementation of an intervention within a complex organisation
  • hypothesis that brief psychosocial (the interrelation of social factors and individual thought and behaviour) risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychosocial and workplace factors for delayed return to work, can achieve better results than usual (stepped) care