Work organization and patient care staff injuries: the impact of different care models for "alternate level of care" patients

Am J Ind Med. 2003 Oct;44(4):392-9. doi: 10.1002/ajim.10277.


Background: The number of elderly patients who do not have acute-care needs has increased in many North American hospitals. These alternate level care (ALC) patients are often cognitively impaired or physically dependent. The physical and psychosocial demands on caregivers may be growing with the increased presence of ALC patients leading to greater risk for injury among staff.

Methods: This prospective cohort study characterized several models for ALC care in four acute-care hospitals in British Columbia, Canada. A cohort of 2,854 patient care staff was identified and followed for 6 months. The association between ALC model of care and type and severity of injury was examined using multinomial and ordinal logistic regression.

Results: Regression models demonstrated that the workers on ALC/medical nursing units with "high" ALC patient loads and specialized geriatric assessment units had the greatest risk for injury and the greatest risk for incurring serious injury. Among staff caring for ALC patients, those on dedicated ALC units had the least risk for injury and the least risk for incurring serious injury.

Conclusions: The way in which ALC care is organized in hospitals affects the risk and severity of injuries among patient care staff.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Occupational / statistics & numerical data*
  • Adult
  • British Columbia / epidemiology
  • Humans
  • Logistic Models
  • Models, Organizational
  • Models, Statistical*
  • Nursing Staff, Hospital / organization & administration*
  • Nursing Staff, Hospital / statistics & numerical data*
  • Occupational Diseases / classification
  • Occupational Diseases / epidemiology*
  • Progressive Patient Care / organization & administration
  • Progressive Patient Care / statistics & numerical data
  • Prospective Studies
  • Risk Assessment
  • Trauma Severity Indices
  • Wounds and Injuries / classification
  • Wounds and Injuries / epidemiology*