Hospital unit working conditions and risk for employee injury

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.