Hi Patrick,

I am assuming that your employee health clinic is different from the occupational health clinic that sees external worker's comp - is that right? Is the ED asking employee health to provide after hours care for patients who will follow up in occupational health?

You may want to start by talking with your in house legal counsel and establishing a clear scope of patients your employee health clinic can legally serve. This varies among institutions depending upon how you are situated and funded. Many internal employee health services are funded by the institution and do not charge for care provided to employees, in which case the funding source is unlikely to authorize that budget to be used for non-employees, especially if they are not affiliated with your institution. At least the ED has a mechanism to bill private insurance or workers comp.

A rhetorical question: how does the ED plan to "get out of the BBP exposure business" for sexual assaults and other nonoccupational exposures, like injuries sustained in a fight with mucosal exposure to the assailant's blood? They obviously need to retain protocols and competency to manage those exposures, so what's the concern with managing occupational exposures? It sounds like they are able to hand off the worker's comp and OSHA requirements to partners in the institute next day.

Colleagues,

I’m trying to ascertain, in your respective institutions, where you direct non-employees with potential blood borne pathogen exposures for evaluation and care (including PEP, if indicated).

Our ED colleagues would like to “get out of the business” of seeing BBP exposures, and would prefer these exposures (irrespective of employment status) to be managed by our employee health clinic, to which we are pushing back, and trying to explore other options.

What we currently do at UIOWA is:

Our own University of Iowa healthcare employees are evaluated during the day by our employee health clinic and after hours/weekends by a nurse call line (aka STICK-line) that follows an algorithm to determine source patient and exposed employee lab testing, risk assessment, and prompt dispensing of PEP meds if indicated though a collaborative practice agreement with our hospital pharmacy. We have previously published our experience with this program (DOI: 10.1016/j.ajic.2024.01.002 )
University of Iowa health science students (e.g. medical/nursing/PT/rad tech students) are managed by the University’s Student Health service during the day and by ED after hours.
Visiting/rotating non-UI health science students on electives are referred to Urgent Care/ED and are advised to contact their own institutional student health program.
Contracted staff (e.g. travel nurses working in our hospital and clinics) are referred to Urgent Care / ED, and thereafter for follow up to occupational health clinic (subject to approval by the Agency’s work comp program).
Visiting residents/fellows/faculty are referred to Urgent Care/ED and advised to contact their own institutional employee health program. Can be seen in occupational health clinic for follow up, subject to work comp authorization.
Local EMS responders with BBP exposures are seen in Urgent Care or ED, and follow up is referred to occupational health clinic (subject to work comp approval).
“Good Samaritan”/bystander exposures are seen in Urgent Care or ED and referred to PCP or ID clinic for follow up.

I’d appreciate any feedback regarding your processes. I’m sure other institutions have also struggled with how to manage employees vs. non-employees who may be exposed while caring for our patients but, due to work comp and other considerations, may have different (and potentially less timely) assessment and care following BBP exposures.

Pat

Patrick G. Hartley, M.B., B.Ch., B.A.O., M.P.H.
Medical Director: University Employee Health Clinic
University of Iowa Carver College of Medicine
patrick-hartley@uiowa.edu