Audit of sickness absence and fitness-for-work referrals

Abstract

Since referrals in relation to sickness absence and fitness to continue work constitute an important part of occupational physicians' workloads, a study was carried out to audit this activity. Randomly selected referrals (u = 162) were audited by external peer review in relation to the information provided in the referral request, the consultation records and responses of the occupational physicians, and the response times linking the referral, the consultation and the response. The study showed that the referral record was adequate when specifying or quantifying long-term absences (90% and 84% of relevant cases, respectively) but questions or information regarding other relevant issues were much less frequent, eg only 12% of the referral records provided a description of the job or task. The physicians' response rate was high in relation to likely date of return to work (96%) but lower for other relevant items. In all the issues audited, the frequency of the physicians' responses was higher than the frequency with which the relevant questions were posed to them, thus suggesting 'added value' in the formulation of the problem by the physicians. The response times (often interpreted as a measure of health care quality) did not correlate usefully with the completeness of the responses as determined by peer review audit. Occupational physicians should aspire to achieve a validated standard of assessment and communication which can be audited.

Evaluation research in occupational health services: general principles and a systematic review of empirical studies.

“…With the exception of the study on sickness absence and fitness for work by Agius et al, 68 the objectives of the studies on input or structure of OHSs were not evaluated against certain criteria. The information in most studies in this section may therefore be considered more as a description of input and structure of OHSs in diVerent countries than a real evaluation.…”

Current occupational health policy issues for universities in the United Kingdom

“…At the level of the individual employee, Agius et al (1995) have audited 162 referrals of employees by managers in relation to sickness absence and fitness to continue work. The information provided in the referral request, the consultation records and responses of the occupational physicians were evaluated.…”

Development and evaluation of a quality assessment instrument for occupational physicians.

“…The method is objective with explicit criteria for quality assessment and the agreement between raters was good. This explicit method is an alternative for a medical audit as described by Agius et al [8][9][10] They presented no guidelines, explicit indicators, or criteria. So, it is diYcult to discuss the method they used and to compare the results of their studies with others.…”

“…Some studies, especially from the United Kingdom, Finland, and the United States, refer to this topic. [8][9][10][11][12][13] However, a clear basis for the definition of good quality practice is often lacking, [8][9][10] or the emphasis is on procedures instead of the content of care. 11 14 Therefore, we decided to develop and evaluate a method for defining and measuring the quality of the occupational physician's contribution to occupational rehabilitation.…”