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Healthcare Reform: Increased Demand Intensifies Safety Concerns

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   May 20, 2010

As the initial waves of the newly passed healthcare reform law begin to ripple out, safety committee members should consider how the changes could affect environment of care and occupational health concerns.

"To the extent you believe the healthcare reform law will increase the demand for services, it could certainly have the effect in the near term of straining the resources of hospitals … [and] that would affect [managers] who are overseeing the safety and health of employees," says Bradford Hammock, partner at Jackson Lewis, LLP, a law firm in Reston, VA, where he heads the workplace safety compliance practice group.

The law will provide coverage to about 32 million uninsured people and offer tax credits to about 4 million small businesses to help cover the cost of insurance for their employees.

Emergency departments (ED) are already among the top locations in medical centers for violence between patients and staff.

"You have overcrowded emergency rooms right now," says James Blair, FACHE, president and CEO at the Center for Healthcare Emergency Readiness in Nashville. "You're going to make 30 million people eligible [for insurance]. They won't be coming hat in hand."

When people believe they have a right to medical care—"and that's what the rhetoric has led everyone to believe, that everyone in America is covered," Blair says—some individuals may be difficult to physically control when they find out at the ER that they have to wait until certain provisions for covering the uninsured kick in over the next four years.

Hospital security expert Fredrick Roll, MA, CHPA-F, CPP, agrees.

"I think a greater number of folks will show up and push for their 'entitlements,'" which will up the ante for workplace violence in medical centers," says Roll, president and principal consultant at Healthcare Security Consultants, Inc., in Frederick, CO.

Others aren't so sure about a long-term increase in ED visits. Although there may be a spike in traffic in the near future, the long-term situation may see fewer traumatized people arrive at the ED as more ill people seek treatment from primary care physicians, says Randall Snelling, CPEO, chief physical environment officer at DNV Healthcare, Inc., a hospital accrediting group based in Cincinnati.

"Once everyone gets their arms around it . . . folks won't be coming to the ER with stomachaches," he says.

A sudden increase in patients could also further stretch the supply limits of a hospital. It's already tricky enough determining just-in-time inventories of surgical masks, latex gloves, food, and other provisions. Now hospital planners and emergency managers will need to get a firmer grasp on how healthcare reform could tax the supply chain.

Although not a potential disaster in the traditional sense, healthcare reform, by potentially bringing more people into hospitals, will challenge facilities by depleting them of supplies more quickly, Blair says.

Whenever a major regulatory change occurs that affects an industry directly, implementing the changes takes away resources from other areas, such as safety and occupational health, Hammock says.

"The reality is you have X number of people to do things," he says. "When something major comes along, you'll pull resources from other areas."

An interesting note: A provision in the healthcare reform bill establishes a National Healthcare Workforce Commission, which will include among its roster healthcare workers and employers, writes John Howard, MD, director of the National Institute for Occupational Safety and Health (NIOSH), in his NIOSH Science Blog.

The workforce commission is expected to submit recommendations to federal lawmakers and agencies to improve the safety and worker protection for healthcare employees, Howard writes.

Editor's note: This article was adapted from a story that ran in the June issue of Briefings on Hospital Safety, which can be found on The Hospital Safety Center.

Evan Sweeney is an editorial assistant at HCPro. He manages and writes for Briefings on Infection Control, a monthly newsletter directed at IC compliance. He also blogs for OSHA Healthcare Advisor, a resource center for infection control and safety professionals, and regularly contributes to Medical Environment Update and OSHA Watch, which focus on healthcare employee safety and health.

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