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Home » Health Professionals » General Information » Red and Yellow Flags

Red and Yellow Flags

 

Flags are warning signs of potential barriers to recovery from injury or illness. The two most commonly utilised to identify workers at risk are “Red and Yellow flags”

 

Red Flags refer to clinical bio-medical features that may indicate serious but relatively uncommon conditions or diseases requiring urgent evaluation. In a discussion paper presented by NSW Workcover Authority: ”Work Related Activity Programs for the Prevention of Long Term Disability in Workers with Musculo-Skeletal Injuries (Non-Red Flag Conditions) Health Provider Guidelines”, red flags were described as conditions that included tumours, infections, fractures and neurological damage. Recommendations are made that immediate notice be taken if an important red flag is present and consideration given to medical intervention. The nominated treating doctor (NTD) should consider or request referral to an appropriate specialist or investigations. “The Red Flags equal physical risk factors”.

 

Yellow Flags are non-medical barriers to recovery. They may be psychological, or social. The greatest risk for long-term disability relates to yellow flag conditions

 

YELLOW FLAGS INCLUDE:

 

Family Barriers

Included weak family support for RTW, over protective partner, partner overly involved in workers injury or management of claim, no support person to talk about problems, over protective significant other.

 

Attitude and Belief Barriers

Include belief that pain is harmful or indicative of ongoing or further tissue damage and that any activity that leads to an increase in pain is potentially damaging, belief that injured part must be diagnosed and treated first, belief that work or other activity will increase pain and should be avoided, belief that pain is uncontrollable.

 

Compensation Issues

Negative experiences when notifying injury to employer – such as being discouraged from making claim, employer requests insurer deny claim, lack of early assessment of RTW barriers by insurers, perception of uncaring or inefficient claims/case management, injured workers engages representative to negotiate with employer or representative in circumstances where this would not normally be necessary.

 

Treatment and Diagnosis

Health professions sanctions disability e.g. a GP continue to certify unfit, health care provider continues to encourages passivity and discourage activity, conflicting diagnosis over injury, health care provider will not communicate with insurer or providers, advice to withdraw from job or work from home.

 

Older / Other Occurrences of Injury, Previous Injury

With extended time off work, previous compensatable injury, older worker.

 

Return to Work Status

Negative attitude to RTW of injured worker, employer or treatment provider; not RTW at 52 weeks predicts very poor RTW rate.

 

Work

History of manual work in occupations such as construction, farming, forestry and fishing, nursing, truck drivers labourers; work history that includes job dissatisfaction, frequent job changes, poor vocational goals, unsupportive or unhappy work environment, low educational background and economic status, lack of availability to do suitable duties at a work site, employer has no RTW program; job involves shift work and unfriendly family hours.

 

Emotions

Depression, fear of increased pain from activity, anxiety, presence of social anxiety, feelings of uselessness and not being needed.

 

Behaviours

Use of extended rest to cope, reduced Adl’s, History of poor compliance in exercise programs, has not RTW within usual time frames for that injury, reports of high to extreme intensity pain - >8/10, poor sleep quality, high intake of alcohol or other substances since pain.

 

Screening for Yellow Flags


Treating doctors, other treatment providers, and rehabilitation service providers who are aware of these yellow flag barriers can and should be looking for warning signs whilst assessing or treating their patient. NSW Workcover suggests using the Orebro Musculo-skeletal Screening Questionnaire. Recommendations are made that a score of 105 must be investigated further. A score of 130 or above was cited as accurately predicting 85.7 % of back injury cases that failed to RTW within 6 months.

When yellow flags are identified or suspected the injured worker should be referred for a comprehensive assessment to a psychologist, clinical psychologist, psychiatrist or other suitability qualified professional for assessment. The type of strategy recommended will depend on a number of factors including the level and nature of psycho-social barriers, the time since injury, the injured workers responsiveness to accepting help, and personality factors of the injured worker –e.g. who may or may not be suitable for group programs (see information pain management end injury adjustment and reference below).

 

For a more complete list of barriers and further information refer to the following Reference, ”Work Related Activity Programs for the Prevention of Long Term Disability in Workers with Musculo-skeletal Injuries (Non-red Flag Conditions) Health Provider Guidelines”

www.workcover.nsw.gov.au/Publications/General/DiscussionPapers

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