Hospital unit working conditions and risk for employee injury

Healthcare employees, particularly in pediatric hospitals, are at high risk of occupational injuries. However, few studies have examined hospital unit-level factors that contribute to these injuries. This study aimed to explore and quantify such risk factors in a large pediatric inpatient setting.

We conducted a secondary analysis of prospectively collected data for about 7,929 unit-days between 2014 and 2017. Data sources included an institutional injury surveillance system, incident reports collected from a sample of employees through active surveillance (voice recording), and hospital unit-based measures of patient density and employee workload. Potential determinants of injury among hospital employees included shift length distributions, staffing metrics, patient aggression, near-miss events, and prior injuries. Mixed-effects logistic regression models with unit-level random intercepts were used to evaluate the association between unit-level risk factors and the odds that employee injuries were reported on a unit on a given day.

Shifts exceeding 13 hours on the previous day were associated with 3-4% higher odds of injury, while same-day shifts shorter than 8.5 hours were associated with a 1% reduction in injury odds. Patient aggression was identified as a significant predictor, greatly increasing the risk of injury, but the association was no longer statistically significant after adjusting for prior injuries. Prior week injuries remained a strong and consistent predictor of future injury occurrences. Near-misses detected in the past week were a significant predictor of injury reporting in unadjusted analyses, but the association was not statistically significant after adjusting for other factors.

Unit-level risk factors-including work shift duration, patient aggression, and prior injury occurrences-play a significant role in employee injury risk. These findings support the importance of continuous monitoring and targeted interventions, such as shift scheduling limits and systematic near-miss reporting, to enhance occupational safety in pediatric hospital settings.