Guidance for Occupational Health Services in Medical Centers

Guidance for Occupational Health Services (OHS) in Medical Centers is dedicated to the memory of Dr. Geoff Kelafant, who was tragically killed in a diving accident in March 2004. Geoff was the original author of a set of guidelines for the practice of occupational health in medical centers and developed the idea to establish a public access internet site to assist practitioners of medical center occupational health (MCOH). For over 10 years, he developed and maintained the guidance document, added a broad range of additional information and links, and summarized information essential to the care of medical center-based working populations. Geoff did nearly all of this work without financial support and was steadfastly dedicated to improving the quality of medical practice in our field. In addition, he established an on-line discussion forum to address MCOH practice issues. Geoff oversaw the forum with his own unique and wonderful combination of biting wit, good judgment, and pithy commentary. Geoff was a dear friend and respected colleague. He was bright, funny, kind, and brutally honest. His gifts to those who practice MCOH have been inestimable; his absence leaves a void in our professional lives and for a great many of us, in our personal lives as well. Few have contributed as much to our small field. Geoff’s enduring legacy is the profound impact he made on MCOH in the United States and Canada. His work supported the creation of a real community, a common purpose, and a set of standards among those of us who practice in the field. In many cultures and belief systems, we live on in this world because of our good deeds; Geoff will live longer than most. Purpose of This Guidance Document This document represents a collation of pertinent guidance, best practices, and professional opinions applicable to the practice of occupational medicine in the medical center setting. Its intent is to provide assistance in handling the broad range of issues encountered by hospital-based occupational medicine practitioners. The guidance document and its hyperlinks will be updated periodically to incorporate new information as it becomes available. Role of the MCOH Provider Medical Assessment of Employees Occupational health practice in a medical center setting requires the same skills as such practice elsewhere, including thoughtful administrative management; knowledge of and interactions with safety, industrial hygiene, and toxicology; and sound preventive and clinical medicine, including surveillance, assessment of history and physical findings, diagnosis, treatment, and disposition. Preplacement Medical Evaluation (PPME) The PPME usually represents the first clinical encounter for a prospective employee, setting the tone and defining expectations from OHS. The PPME, which must be done after the offer of a job, serves to document those existing medical issues that are likely to have an impact on the new employee’s performance, health, and safety in the health care work setting. It is not designed to diagnose or treat previously undiscovered medical problems. The Americans with Disabilities Act of 1992 requires job descriptions that identify the “essential functions” of the job to be offered, with specific, precise descriptions and terminology with which employee capabilities must be compared. OHS should gather enough information to ensure that employees’ medical and functional status enables them to perform the essential functions of the job. OHS should outline the specific constraints and restrictions that human resources (HR) can use to determine appropriate accommodation, where and if feasible and appropriate. Nevertheless, specific diagnoses or other clinical information should not be released. State laws differ, but occupational physicians must be aware of local licensing and skill requirements. In general, they must act as a resource for nurse-level and midlevel provider- based evaluations and should be involved in any communication with HR about restrictions or failure to meet medical or functional standards for the offered job. Refusal to clear someone for work must be based on the issues of “direct threats” and on inability to meet specific standards. For example, a known alcoholic in acute relapse may not be suitable for hire, if existing policy states as such, but a cocaine addict who has completed rehabilitation cannot be refused employment on that basis alone. Conditions identified during the course of the PPME, such as increased blood pressure, should be communicated to the individual with recommendations for follow-up, preferably in writing. New employees should also be fully informed of any recommended restrictions shared with HR. The PPME documentation should be housed in a record/database separate from the institution’s medical record for patient care, primarily for access at a later date and to clarify the purpose of the data for evaluation rather than general health care. Of course, the data should be available to the providers of the health care institution if the new employee wishes to release the information to them according to the Health Information Portability and Accountability Act (HIPAA) of 1996 rules. Other evaluations, such as drug testing, commercial driver certification, baseline medical status before working with hazardous chemicals, immunization status, examinations for respirator clearance, or tuberculosis (TB) surveillance status may be required before starting work, but some may be delayed until specific job assignments have been clarified. Specific regulations apply to some functions, such as flight examinations or drug testing, requiring specific certification by designated agencies such as the Federal Aviation Administration or testing and certification as a medical review officer under Department of Transportation Guidelines. Periodic Medical Evaluation The health care workplace represents a very hazardous environment (see Workplace Hazards). Engineering and administrative controls should the use of personal but medical surveillance for health from hazardous represents good medical practice and is required by the and some laws for specific is required for The Occupational and Health Administration Centers for and guidelines on as and the for Occupational and Health surveillance for employees to hazardous a of support for or For to and standards medical surveillance are states have an for with or that may to practice OHS is of the administrative that such providers to the licensing and those providers to ensure with the of the of as in and other and communication with in and record are essential for Medical Evaluation have physical the PPME is specific to the job. OHS should have an with HR to review employees who are to that have specific physical requirements. This may a review of the employee’s medical status, any or restrictions work a evaluation is required for the new job, the employee should that same a record review a of skills and or a of OHS should the employee for or a and are best and by an occupational health in OHS. health care may have the to care elsewhere, the of care from an are to physical and other with the and communication with care and OHS must good with all and and a in clinical For those employees care and who have restrictions or a of from work, the OHS should periodically the employee and to with the The should provide information to the or to HR on as required by OHS as the for communication other providers and the employee’s HR. or should be to if they work in the of OHS providers should the employee before he or to work, or establish for to work that the employee’s must have a policy requiring OHS after a or may also evaluation to determine restrictions in the a to the employee and to from work, many OHS may offer acute care such as employees the OHS because they on to and from is that are available to work Conditions with for and can be identified Medical should be for and other or and other OHS should establish specific and evaluation may be a on is or or physical on evaluations should with a from the of the specific in The should the employee to OHS. The employee should not be to work until OHS has a and any the is to to work in some the of the evaluation should be as a are and the to the that the was or was not to a medical and and under the employee may to may be with OHS on a basis if a or that work is by a real or medical OHS can the of the medical and that will in the OHS must the to all to a medical or of This is in any work but the to may be in a health care Medical The of OHS in Health and of OHS in a health care setting is a and requires of the the of the care and the are essential to establish a with of the the OHS in is usually the medical that may be in health care, if the is the of the and The OHS medical should have access to the medical OHS can provide to ensure care, appropriate and to after an or but job and may Role as a The OHS medical must be to in other that OHS is not in the of or from other Medical are of the of occupational medicine and its The OHS medical must clarify the of OHS for in medicine, and be as a in the of hazardous and the of medical care with and regulations Medical Act Americans with Disabilities and support to with such issues for care, including are in a The medical of OHS must with that may be to other physicians in the medical including safety, industrial hygiene, environment and the institution’s to and at of supported in the and in the during and are to an OHS as a medical of OHS primarily on the with occupational health and other and of skills and opinions the of a should be to developed policy and from as for and such as blood and surveillance, providers can much of the clinical may from at such as the Occupational Health of and they for or to of a should be in OHS if they meet work performance, work, or requiring requires of on the of the a a should the medical and work status from other providers with the for communication with the employee or to the medical for OHS must be to have from the to with the and (see medical and is in health care than in any other and and the the same may be housed of OHS but communication with OHS for of restrictions and of work work should be available restrictions from an occupational or OHS can as a resource to to the and to work in the original or in job the The of this on HR absence and and the the employee on on and with and but OHS must be to issues and to to a to some the Health Administration from OHS may be because health for In occupational medicine providers may a in to address general and workplace safety, and other health OHS as a resource to employees them they from an available in the health care setting is for of issues in the and to all in the of medical diagnoses and may of such issues the medical not establish an with the as a patient and not on a may be an but are some to in The medical may to as a to the for about and as as to gather data as to any in employee or of problems. in a work an can in an to the in that to a before individual or of that will or the health care and of a great of with in of a physical and in of Medical OHS must it is of the practice of the health care or of the This are who has access to which and a release is individual may it is usually to OHS as of the This communication the medical and the other providers in the OHS must have specific from the to release any medical information to the OHS will not to medical information with the with a work status should be of health Medical and documentation should be housed in a record/database separate from the institution’s medical record for patient care. It should medical surveillance, and should not be to without the in care of the the data should be available to health care providers if the employee wishes to release the information to Health and Occupational Health The on of Health requires that have a safety skills in safety, industrial hygiene, and clinical of some of and quality and on to the of problems. of to safety, health, and represents a for an without which will on of Health requires some of record the many and have developed to the in a of This is in a in health care, an of a safety or other with a and to the but OHS in functions is essential for the of The of this for which the or safety should of medical surveillance medical evaluation for and and medical support for of to employees the of review identify should have and the in an to the they are of with a of skills and and and employee establish a set of by which for review are or all or all than a set of or by of evaluations of the environment of care can identify to and work with safety, employee health, and employee an for safety of and the of the of of may be to a of immunization and as as appropriate evaluation and medical must be human and and the and under acute and and by and and may such as those with handling in and that and to and of are surveillance should also be in to of and to and should the including documentation of surveillance testing, and to work Periodic to preventive and use of and in the use of and Periodic review of employee to and of employees for respirator review and updated testing to and medical of for and to of employee health and work and personal work to of for Health Employees of may be or in on the of or the to the for which immunization is for which may be increased among but should be including and as appropriate for a of with safety should be and where should not be or before should not be to of and status and to the and are and regulations by some states for patient testing without the of the and and should be and of the to or should be at and guidance with to or of specific should be (see specific In all of or which as as the common a with a health care should be offered to the Information should be to determine the employee is a of a The employee should be to any that the after of and any acute on the use of or to of during the after should be of should be for if they to and information should also be Information should be of and first should be for all and including the site and the is to the should be Preplacement testing for is a in some states that a who has a must have it as a of an occupational is to the Preplacement testing, where may to the from as as the employee aware of the of a and of is and practitioners should in the are evaluation and Preplacement testing for and to and for or is to blood is with a of to if a patient is but to if the patient is is to and and may on for to with blood and according to be offered for previously for should have documentation of to the testing should be among previously without such with without a after of not provide that an individual is a to the of such as a of the evaluation a of to later by of who should have the with testing for who are without a and to should be and a should be for the of and if about who have or may to that they are of that this will on who perform may to some of if they have Nevertheless, can work with with also may be that is and OHS can assist with for such patient has not been to of should be and to Guidelines. should the of to or with and other and should be available and of after is that may be with of of the with an or or to an individual with of after has been at based on in In to the for the for with should be on an individual basis by the employee health the employee, and should be made available or and of to the employee if the employee to the baseline is the employee should for testing at appropriate for at the patient has been identified as not or and is not of a for drug and are of any surveillance to of among from to with an of after to be much to may be to of and may of is have acute of with is a of is and of is have the of in acute has in of was during acute at an of after It has been that with acute are likely to clear the than are with clearance, of in of acute but among with acute the with acute and the of and is for in or to blood or should be for should have evaluation and of any of should be and before to work is HR that provide for such may employee use of and should be and during site is in and during acute acute with to may be in and of not the of patient to an but may also the for the should be offered to all employees of and among employees with patient including or of all employee with have been to in with may be for during and are recommended for for with For including should be in with and For with should be or of is or should be according to guidelines should be to determine the for based on the employee’s medical and work and Employees with or should have status For the general a history of in an in the United States is a of Employees with or of should have status by a Employees in are at of employees who are to should be from work in patient from the after to the may to establish a policy requiring status documentation at hire, to for of and after an Employees with should be from patient work until all are and employees with should be from for until are but may care for other as as are employees with may have of and should be from patient care until are not as as to should be for those employees who are not the employee should be from patient care until are from may over employees may not be fully if they are to later in The OHS should a record of and the medical of all those with specific after who are to after the OHS may them for the of to after and them from 10 to after if is not resources not from the workplace is is the employee should be informed that a of is who any with should to OHS for resources employees may also from during the The is for than years, of Nevertheless, it should not be to who have the should have to and of should be by a of from a or health care documentation of at of employment without or by if the employee is should not be during and specific should be of for at a live should not be to with The on has guidelines on the use of in based on patient and history of is not of of have among is by and and is for with to in common use or for has been and is recommended for The best to of is not clear at this it is may or be to It may be to offer to based on the work and other a to health care and from on a drug is a in drug and with care, and are at institution should a policy that and and for appropriate surveillance and testing is recommended for at the of hire, of the is the for new blood for which which are specific, but have been for use as an to the and may for testing of employees previously with as as evaluation and of should the employee with available of by of institution should be with or in a may have an and should be surveillance are if they the at with the should also be and by should be to the with a should be offered with of than should also be offered as should with a at of Conditions that at of on with treatment, or and and an of are to of or should be and employees after for the requires and and testing of respirator should be available and in patient care of medical a new human by a The which to be primarily by and to than In some primarily because of delayed of the among nearly from to a of was by an of about to 10 and by with did not the to of to the for in and with The in to is of and of have of in for before the that they with the In such it was that a patient and and a in guidelines for to with or for on the The of and among in and acute care is designed to in and other of including of Occupational and medicine practitioners in medical centers should be involved in to for of are those which can be or from to which in and have for public health which public and and which required for public health are to in and and specific of and those that be for in the because of of and and for and and the and of safety and safety such as and are to be of in for from to in medical center and other issues pertinent medical center can be at and unique to with safety, and is required to ensure that and other controls are in to occupational and in this setting. from the of as as may to of are from requiring that occupational and medicine physicians work with to determine which employees may be at for and such as and Other hazardous may to chemicals, and medical and surveillance should be developed in the of medical and physical and occupational health for with based on the controls should be in to access to and in the occupational health The institution must identify which are to and provide appropriate and The occupational health of should be all and a of occupational an surveillance is the of the This may of a medical evaluation if are must be in a with appropriate to because the of occupational in this is to may to all in a to that can be immunization or medical For the occupational health should provide appropriate immunization medical by and other and by Other such as by knowledge to medical care and to in the of a or The occupational health for must and have with the and and for must be established and communicated in requires of testing for the and the human a of occupational health for has to be of for or may be a to the it should not be as a for thoughtful medical has common for and medical Employees should be and in of health clinical work in without of should be with an of and a to access for a course in the of from an that to of the world where is and where existing have not been to may use of that available to to such should clear that the has been with of that is by and that all other must to be of its with testing, surveillance among must be the immunization guidelines are by the evaluation testing should be as if has during or after in health care and working with medical such as and OHS should support the of a safety The should medical surveillance surveillance safety and review in of work from by an in including in and and from or from and problems. health care work have industrial with including and surveillance may be for safety, and and in in the use of Health care should be in safety that incorporate and best practice should as of should medical surveillance surveillance and safety and review of and for employees to hazardous and in the The use of in and has increased the for safety a of safety and specific medical issues pertinent to baseline history and is recommended by This may use of precise testing, examinations to document should be and should be for of to the and controls may be to the of should with and regulations and and the safety should from the employee health medical and as as medicine, and physical issues in all in health care Of are and to be the of among data that the of is among and the of in industrial is an with and the OHS should work with and safety in the and of and The of and and the of to with are has to the where are and in many to patient and handling are common in acute care should of assessment of of and of of patient handling has been with in among acute care may be to a of can during or during working The may range from to occupational or OHS should have access to clinical appropriate industrial and recommended and centers may be in information are available to provide and other information on is available centers can be very in information on the of occupational states have to requiring about hazardous in of health employee’s knowledge of and work is essential to occupational institution should to ensure that are with and to work of requires to employees aware of to which they may be the use of safety data and must be developed and safety made available. are OHS should ensure that are to use testing, care of and surveillance from OHS. should be available at the as as at OHS. information should be communicated and a communication should the to access and use available information and and and of at the and the use of work practices, and and should be Specific to have been identified as a for health care providers and The is and may be The delayed as an local It is usually not to but primarily to added to of during is a local and to that is with of which may to or to may by or by of may be to it has and are by and may be with testing or testing with Information about should be to and should identify respirator and

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.