The Occupational Safety and Health Administration issued earlier this year expanded injury-reporting requirements, effective Jan. 1, 2015. Some are worth looking at, as OSHA appears to be signaling that it's quite unhappy with the state of work injury surveillance in the country. It is convinced that better surveillance leads to fewer injuries.

The new rules include a requirement that fatalities be reported to OSHA faster, that all non-elective hospitalizations for treatment shortly after a work injury be reported within 24 hours, and that amputations and losses of an eye also be reported within 24 hours.

OSHA currently requires about 1.5 million “establishments” to record injuries and illnesses. This is about half of all establishments with more than 10 employees and one-fifth of all establishments. With all 7 million establishments now covered by these new rules, and assuming full compliance, there will be for the first time an estimate of the number and nature of serious acute injuries.

OSHA estimates that non-elective hospitalizations for acute injuries occur about 110,000 times a year. Data from Washington and California suggest this estimate is reasonable.

The Washington Department of Labor and Industries released an analysis of hospitalizations in March 2014. Construction accounts for a quarter, manufacturing 12%, and agriculture, forestry, fishing and hunting 9%. The remaining are scattered among many sectors. Susceptibility to hospitalization due to injury increases gradually by age from early adulthood, then jumps among late- and middle-aged, as well as elderly workers.

Several states already require prompt reporting of all hospitalizations. In states about to be covered, employers and their agents are going to have to learn how to get hospitals to respond within a day about the reason for admission.

Commenting on the draft regulations, American Supply Association wrote, "There is no evidence that reporting isolated hospitalizations to OSHA would meaningfully improve safety within the workplace." In the Federal Register publication of the final version, OSHA didn’t provide evidence, but cited a Massachusetts official who wrote that “Serious occupational injuries are urgent sentinel health events indicating that prevention efforts have failed and that intervention to remediate hazards may be warranted.” In other words, a lot of these reports may lead to a citation.

And, OSHA says, citations lead to fewer injuries. “Studies have shown that OSHA inspections can lead to a reduction in the rate of injuries and illnesses, and that the effect is greater where injury and illness rates are higher and where the inspection finds violations that result in a citation. Most studies reviewed showed reductions in injuries and illnesses at a given facility only when the inspection uncovered safety and health violations that resulted in citations.”

The new rule on amputations may get to the heart of OSHA’s greatest concern, which may be that very many serious injuries occur and are treated, as it were, off the grid. The Bureau of Labor Statistics reported in 2009 5,930 amputations. Yet the National Institute for Occupational Safety and Health thinks that about 15,000 amputations occur a year, treated by hospital emergency departments, some 78% on an outpatient basis only. The vast majority of amputations appear to involve one or more fingers.

Researchers in Michigan have, since the late 1990s, been looking at gaps in reporting of work injuries, and how many escape official injury records and the workers’ compensation system. They used multiple data sources to track the path of care for several types of serious injuries. For burns, they found “three times more burns than the Bureau of Labor Statistics’ employer-based system. The Bureau of Labor Statistic's 2012 estimate of skull fractures in Michigan, which includes facial fractures, was 170, which was 53.8% of those identified from our review of medical records.” For all work injuries, the workers’ compensation system failed to record 66% of injuries and illnesses, and the OSHA logs failed to record 68%.

Judge for yourself if these rules make sense.

Some documents reviewed for this column:

Federal Register, Final Rule: Occupational Injury and Illness Recording and Reporting Requirements--NAICS Update and Reporting Revisions. September 18, 2014.

Kica J et al. Multisource Surveillance System for Work-Related Burns. J Occup Environ Med 2006 54 (5).

Kica J et al. Surveillance for Work-Related Skull Fractures in Michigan. J of Safety Research 2014 51.

Rosenman, K. et al. How Much Work-Related Injury and Illness is Missed by the Current National Surveillance System? J Occup Environ Med 2006 48:357-365.