Effective decision-making tool identifies risk factors

Have you heard of the term flag? It's often used in rehabilitation and workers' compensation to identify risk factors.

It aims to help providers identify appropriate interventions and barriers (including non-medical) in the injured worker's rehabilitation process. It can also be used as an effective decision-making tool when injured workers are failing to improve. Providers can help ensure the injured worker receives the best possible outcome identifying and communicating these risk factors with other members of the rehabilitation team such as the doctor, insurer and rehabilitation and return to work coordinator.

There are usually four flags including red, yellow, blue and black.

 

Red flags

 

Red flags are used to identify serious pathology by recognising key symptoms. These may help to identify other serious medical conditions that may or may not have been identified such as:

·         significant trauma
·         unintended weightloss
·         history or possibility of cancer
·         drug use e.g. alcohol, narcotics
·         bowel or bladder symptoms.

Yellow flags

Psychosocial risk factors shown to be predictive of extended injury and disability are known 'yellow flags' and include:

 

Belief:

·       there is major underlying pathology (catastrophising)
·       conditions are harmful and disabling
·       avoidance of activity will help recovery
·       there is a need for passive physical treatments rather than active self-management.

 

Emotional response:

·       depression, anger
·       bereavement, frustration.
External factors:
·       perceived inconsistencies and different interpretations
·       failure to answer patient and families worries.

 

Blue flags

Perceived features of work or social environment generally associated with higher rates of symptoms. For example ill-health and work loss may delay or form a major obstacle to recover from injury. Blue flags include:

·         high demand/low control
·         unhelpful management style
·         poor social support from colleagues
·         perceived time pressure
·         lack of job satisfaction.

Black flags

Black flags are not a matter of perception and affect all workers equally. They include both established policy concerning conditions of employment and sickness policy and working conditions specific to a particular organisation. Black flags include:

·         company policy on rehabilitation
·         threats to financial security
·         litigation
·         qualification criteria for compensation
·         lack of contact with work.

Adapted from:

"Psychology, Personal Injury and Rehabilitation" The IUA/ABI Rehabilitation Working Party 2004 sponsored by The International Underwriting Association of London, the Association of British Insurers.