This study seeks to address the gap in epidemiological data on work-related incidents in a local tertiary hospital occurring during the COVID-19 pandemic and, in particular, the prevalence of abuse and harassment among HCWs. The study aims to identify the trends and patterns in the types of work-related incidents that HCWs face over a 7-year period, from 2015 to 2021.
In this retrospective study, we conducted a descriptive analysis on HCWs work-related incidents between 2015 and 2021 at Singapore General Hospital (SGH). SGH is the largest acute tertiary hospital in Singapore, with a capacity of 1,939 beds, 9,201 staff, and oversaw the care of 75,416 patients in 2021.
Data on work-related incidents occurring from the calendar period of 2015 to 2021 were extracted from the incident reporting platform, Risk Management System (RMS) database, in December 2022 by SGH staff from the Workplace Safety and Health Department (WSHD). The extracted data was anonymised and stored in the hospital database for analysis. The RMS is used by the hospital as an operational database to manage unsafe acts and unsafe conditions leading up to work-related incidents, and to learn from the incidents and remedy hazardous conditions to prevent recurrence. A work-related incident was defined as any situation or occurrence at work which resulted in physical or non-physical harm to the staff. Incidents that were reported in the system would be reviewed and verified by assigned individuals, such as the staff's reporting officers.
As part of the hospital's policies, all cases of work-related incidents are to be reported on the RMS by the affected staff or their supervisor. The affected staff or supervisor is required to provide incident details such as the date and location of the incident, and a brief description of the incident. Subsequently, the supervisor is required to provide their assessment of the incident and details of the medical leave or hospitalization leave.
Based on the description of the work-related incident reported on the RMS, WSHD categorized each incident into one of seven categories. The seven adopted categories are: (1) abuse and harassment; (2) burns/scald; (3) cut, this excludes sharps injuries caused by needles and tools contaminated by potentially infectious patient body fluids; (4) hit by/against object; (5) occupational health disorders; (6) slips, trips, falls; and (7) spill. Sharp injuries were not available for analysis as they are separately tracked. These categories were adapted from the categories utilised by the Singapore Ministry of Manpower for categorisation of work-related incidents. A broad definition of abuse and harassment, consistent with the legal definition under the Protection from Harassment Act 2014, was adopted for reporting purposes. As such, "Abuse and Harassment" was defined as any threatening or insulting communication or behaviour towards a staff which caused alarm or distress to the staff. A broad definition of Occupational Health Disorders was also adopted for this study and was defined as any health condition that could be attributable to work factors. This includes musculoskeletal conditions, dermatological conditions as well as noise-induced hearing loss. Staff who were reported to be suffering from occupational health disorders would be reviewed by either an occupational health doctor or their own treating physician. Supporting evidence of the diagnosis and assessment would be reported in our incident-reporting database. During data processing, staff designations were categorized into five main occupations: (1) administration, comprising of administrative and management staff; (2) allied health, such as physiotherapists, radiographers, medical laboratory technologists and medical social workers; (3) ancillary, consisting of staff providing support to the overall functioning of the hospital such as kitchen staff, housekeeping staff and laundry staff; (4) medical; and (5) nursing staff.
Descriptive analysis was performed to explore trends in work-related incidents for the period between 2015 and 2021. Incidence rates were calculated based on the total number of work-related incidents occurring in a particular time period per 1,000 healthcare staff working in SGH during the same time period. Data on the total number of healthcare staff by calendar year was obtained from the human resources department, and this was used as the denominator to calculate the person-time at-risk. Confidence intervals were calculated assuming a Poisson distribution.
Ethical approval was obtained for use of deidentified data, as provided by the SingHealth Centralised Institutional Review Board (CIRB 2020-053).