Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days

Isoardi, Katherine Z; Armitage, Melanie C; Harris, Keith; Page, Colin B.

doi:10.1111/1742-6723.12755

Cited by 10 publications

(12 citation statements)

References 5 publications

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“…Whilst there are variations in methodology and size of effect, there is a consistent finding across the examined articles, that the presence of inpatient toxicology services in a hospital reduces overall length of stay for patients suffering from intoxication, but potentially at the expense of longer ED length of stay. This effect was also demonstrated when the results were compared to other similar types of presentation [13,15] and controls in hospitals without such toxicology services [13,14].…”

Section: Discussionmentioning

confidence: 66%

“…All of the articles had length of stay as one of their outcomes. Six of the papers consistently demonstrated a reduction in overall hospital length of stay – some by comparison to data with previous services , some by comparison to a local hospital or regional/national average . However, one article reported no such effect, though the original data for this outcome was not provided .…”

Section: Resultsmentioning

confidence: 96%

“…However, one article reported no such effect, though the original data for this outcome was not provided [16]. Some articles further analysed their data with respect to complexity of patientthis was performed either by creating 'non-complex' and 'complex' subsets [10,11], or through novel calculated outcomes that incorporated a patient's complexity [15]. Regardless of the method used, improvements in hospital length of stay were demonstrated across all articles, often with greater benefit than for the overall population.…”

Section: Length Of Staymentioning

confidence: 99%

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Inpatient toxicology services improve resource utilization for intoxicated patients: a systematic review

Legg

Little

2018

Brit J Clinical Pharma

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Aims Presentations of intoxicated patients to hospital are frequent and increasing. We aimed to review the existing evidence that the presence of inpatient clinical toxicology services reduces use of resources without impacting on the care of these patients. Methods We conducted a literature search using the Cochrane Library, PubMed, and Embase for articles that measured length of stay (and other outcomes) for the target population, with toxicology services as an intervention. The articles were reviewed with respect to the ROBINS‐I tool. Results Seven relevant articles were identified. Six of these studies demonstrated reduced hospital length of stay for intoxicated patients in hospitals with inpatient toxicology services. None of the articles demonstrated a detriment in morbidity or mortality. There were also improvements in other resource‐related outcomes. Conclusions The presence of inpatient toxicology services appears to improve resource utilization, in reduction of length of stay, as well as a number of other related outcomes. It does this without compromising on patient morbidity or mortality. Thus, it should be considered as a potential model of care for future toxicology services, especially with current trends of increasing demand for service efficiency.

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Section: Discussionmentioning

confidence: 66%

Section: Resultsmentioning

confidence: 96%

Section: Length Of Staymentioning

confidence: 99%

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Inpatient toxicology services improve resource utilization for intoxicated patients: a systematic review

Legg

Little

2018

Brit J Clinical Pharma

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“…Inpatient clinical toxicology units are an established part of the Australian healthcare system and bring many advantages to the care of poisoned patients, reducing hospital length of stay and making more efficient use of resources [1,2]. In addition to clinical care, many toxicology units routinely collect inpatient data providing high quality information on patterns of toxin exposure, patient morbidity and mortality, and treatments used [3].…”

Section: Introductionmentioning

confidence: 99%

Use of a tablet-based application for clinical handover and data collection

Downes

Page

Berling

et al. 2019

Clinical Toxicology

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Context: Inpatient toxicology services undertake remote as well as inpatient management of poisoned patients. The aim of this study is to describe the introduction of a tablet-based electronic data collection tool allowing data to be captured on inpatient and remote consultations. Methods: Retrospective review of all cases entered in the database from 1 March 2014 to 28 February 2016. Data collected included demographics (age, sex), clinical details (exposure category), presentation facility and disposition. Results: The database included 3616 cases: 59 (1.6%) were excluded due to inadequate details, 122 (3.4%) had no electronic medical record available, 1985 (54.9%) presented to the inpatient unit facility and 1450 (40.1%) were external consultations. Of these 1450, 223 (6.2%) were paediatric (aged less than 12 years), 395 (10.9%) adolescent (12-17 years) and 832 (23.0%) adults (18 years and over). The proportion of paediatric cases (median age 2 y; 45.7% females) with pharmaceutical ingestions was 122 (54.7%; 95% confidence intervals (CIs): 48.2-61.1) compared with 345 (87.3%; 95% CI: 83.7-90.3) in adolescents (median age 15 y; 79.5% females). Of the adult presentations, 659 (18.2%) were metropolitan/regional facility presentations and 173 (4.8%) rural facilities with 125 (3.4%) adults subsequently transferred to the inpatient facility. Median age was 38 years (interquartile range (IQR) 35-52) with 338 (51.4%) females in the metropolitan group and 37 years (IQR 26-48) with 51 (30.5%) females in the rural group. There were more bites and stings in the rural group, 41 (23.7%; 95% CI: 18.0-30.6) versus 54 (8.2%; 95% CI: 6.3-10.5), more recreational substance exposures 27 (15.6%; 95% CI: 11.0-21.8) versus 40 (6.1%; 95% CI: 4.5-8.2) and less pharmaceutical exposures 93 (53.8%; 95% CI: 46.3-61.0) versus 462 (70.1%; 95% CI: 66.5-73.5). Conclusions: The tablet based database provided useful information on populations of poisoned patients not accessible previously. It demonstrated important differences in the types of patients presenting to rural versus metropolitan hospitals ARTICLE HISTORY

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“…Additionally, when available as a consulting or admitting service, medical toxicologists provide direct care at the bedside of envenomated patients. The involvement of a toxicologist in the care of poisoned patients in general is associated with reduced length of stay (LOS) and possibly reduced health care costs . It is unclear, however, what role a medical toxicology service (MTS), in which a medical toxicologist is providing direct patient care, provides in patients with rattlesnake envenomations.…”

mentioning

confidence: 99%

Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake‐envenomated Patients

Levine

Offerman

Vohra

et al. 2018

Academic Emergency Medicine

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Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days

Cited by 10 publications

References 5 publications

Inpatient toxicology services improve resource utilization for intoxicated patients: a systematic review

Inpatient toxicology services improve resource utilization for intoxicated patients: a systematic review

Use of a tablet-based application for clinical handover and data collection

Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake‐envenomated Patients

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