Resource-Use Analysis of a Medical Toxicology Consultation Service

Clark, Richard F.; Williams, Saralyn R.; Nordt, Sean Patrick; Pearigen, Paul D.; Deutsch, Reena

doi:10.1016/s0196-0644(98)70228-8

Cited by 17 publications

(22 citation statements)

References 3 publications

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“…Fractional days *p<0.001, comparing differences among groups, by Kruskal-Wallis test MCC major complications or comorbidities, pt patient, CI confidence interval of shorter hospital stay represent increased efficiency, are directly tied to cost reductions, and result in fewer hospital beds being required system wide. In a previous study limited to patients with tricyclic antidepressant overdose, Clark et al reported less gastrointestinal decontamination and ordering of fewer laboratory tests among 28 inpatients seen in consultation by medical toxicologists compared to 66 patients not seen in consultation [18]. In a descriptive Australian study, Lee and colleagues reported that 192 inpatients admitted to a combined general medicine and consultative medical toxicology service experienced a shorter length of stay than 113 patients not seen in consultation by medical toxicologists [19].…”

Section: Discussionmentioning

confidence: 99%

“…It has also been demonstrated that patients managed with PCC telephone consultation utilize the emergency department (ED) less frequently and experience lower rates of hospital admission and shorter lengths of stay (LOS) when hospitalized [7,[14][15][16][17]. However, very limited data exist regarding consultative bedside management of poisoned patients by medical toxicologists, and no studies have reported major quality outcomes in patients admitted to a medical toxicology service where care was primarily delivered by medical toxicologists [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Effect of a Medical Toxicology Admitting Service on Length of Stay, Cost, and Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses

et al. 2014

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There are no published studies that have compared quality outcomes of hospitalized poisoned patients primarily under the care of physician medical toxicologists to patients treated by non-toxicologists. We hypothesized that inpatients primarily cared for by medical toxicologists would exhibit shorter lengths of stay (LOS), lower costs, and decreased mortality. Patients discharged in 2010 and 2011 from seven hospitals within the same health care system and greater metropolitan area with Medicare severity diagnosis-related groups for "poisoning and toxic effects of drugs" with and without major comorbidities or complications (917 & 918, respectively) were identified from a Premier® database. The database contained severity-weighted comparisons between expected and observed outcomes for each patient. Outcome parameters were differences between expected and observed LOS, cost, and percent mortality. These were then compared among groups of patients primarily admitted and cared for by (1) medical toxicologists at one hospital (Banner Good Samaritan Medical Center, BGS), (2) non-toxicologists at BGS, and (3) non-toxicologists at six other hospitals. Records of 3,581 patients contained complete data for assessment of at least one outcome measure. Patients cared for by medical toxicologists experienced favorable differences in LOS, costs, and mortality compared with other patient groups (p<0.001). If patients cared for by non-toxicologists had experienced similar differences in observed over expected values for LOS, cost, and mortality as those cared for by medical toxicologists, there would have been a median savings of 1,483 hospital days, $4.269 million, and a significant decrease in mortality during the 2-year study period. Differences between observed and expected LOS, cost, and mortality in patients primarily cared for by medical toxicologists were significantly better than in patients cared for by non-toxicologists, regardless of facility. These data suggest that significant reductions in patient hospital days, costs, and mortality are possible when medical toxicologists directly care for hospitalized patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a Medical Toxicology Admitting Service on Length of Stay, Cost, and Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses

et al. 2014

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“…However, further studies to determine the role of Glass in the remote care of poisoned patients are required now that feasibility has been established. In the present era of value-based care, a toxicology service using Google Glass could expand their coverage of healthcare systems and decrease overall treatment costs [8][9][10][11]. Importantly, a simple, unobtrusive HMD such as Glass has the potential to generate revenue (using comparable billing codes used by telestroke services to generate income) that may be applied to toxicology faculty support.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility and Acceptability of Google Glass for Teletoxicology Consults

2015

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Teletoxicology offers the potential for toxicologists to assist in providing medical care at remote locations, via remote, interactive augmented audiovisual technology. This study examined the feasibility of using Google Glass, a head-mounted device that incorporates a webcam, viewing prism, and wireless connectivity, to assess the poisoned patient by a medical toxicology consult staff. Emergency medicine residents (resident toxicology consultants) rotating on the toxicology service wore Glass during bedside evaluation of poisoned patients; Glass transmitted real-time video of patients' physical examination findings to toxicology fellows and attendings (supervisory consultants), who reviewed these findings. We evaluated the usability (e.g., quality of connectivity and video feeds) of Glass by supervisory consultants, as well as attitudes towards use of Glass. Resident toxicology consultants and supervisory consultants completed 18 consults through Glass. Toxicologists viewing the video stream found the quality of audio and visual transmission usable in 89 % of cases. Toxicologists reported their management of the patient changed after viewing the patient through Glass in 56 % of cases. Based on findings obtained through Glass, toxicologists recommended specific antidotes in six cases.Head-mounted devices like Google Glass may be effective tools for real-time teletoxicology consultation.

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“…In the future, the development of a civilian medical toxicology teleconsultation service to assist both local and volunteer physicians in locations with limited subspecialty care may aid in reaching those in greatest need. Furthermore, while studies have demonstrated the effectiveness of poison centers and medical toxicology consultation services, expansion of toxicologists' teleconsultation capabilities to include electronic main, texting, and video consultation may further improve resource utilization and patient outcomes [12][13][14][15]. Further studies are necessary to determine the feasibility and effectiveness of such programs.…”

Section: Discussionmentioning

confidence: 99%

Wartime Toxicology: Evaluation of a Military Medical Toxicology Telemedicine Consults Service to Assist Physicians Serving Overseas and in Combat (2005–2012)

et al. 2014

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Those medical providers deployed to remote countries and tasked with caring for military personnel must diagnose and treat diseases and nonbattle injuries that result from exposures rarely seen in developed countries. Military providers must also function with limited resources and a lack of access to physician specialists, to include medical toxicologists. There have been limited published approaches to addressing this clinical gap for medical toxicology. To address this void, the US Army Medical Department deployed an electronic mail telemedicine system to provide teleconsultations for remote health-care providers worldwide, including Iraq and Afghanistan. This study aimed to describe the types and the frequency of toxicology teleconsultation and consultant responses using electronic mail to assist physicians serving in resource-limited locations. This was a retrospective observational study in which an unblinded data extractor independently reviewed all medical toxicology email consultations. Using a previously developed data collection worksheet, the extractor recorded the type of question asked by the consultant (overdose case, envenomation, occupational exposure, etc.) and the duration of time from when the teleconsultation was placed until the consultant replied. The extractor also recorded if the patient was adult or pediatric and if the patient was US military, US contractor, or local national. The extractor also recorded how often the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. In addition, for clinical teleconsultations, the extractor documented the frequency that the consulted toxicologist (i) provided a differential diagnosis or specific diagnosis, (ii) provided specific management guidelines for a patient, and (iii) recommended to evacuate or not evacuate a patient. The results were analyzed using descriptive statistics. Of the 99 consultations evaluated, the most common consultation was for snake envenomation and antivenom recommendations (n=23, 23 %) followed by accidental chemical exposures (n=14, 14 %), drug testing (n=13, 13 %), and substance abuse (n=10, 10 %). In 41 % of consults, the toxicologist provided a differential diagnosis or specific diagnosis, and in 60 % of cases, the toxicologist provided specific management or evaluation guidelines. In 11 % of cases, the toxicologist recommended for or against evacuation of the patient. In 25 % of consults, the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. The most frequent consultations for the military telemedicine consultation service were for direct patient cases, specifically snake envenomation management and accidental chemical exposures. Our results may be used to educate physicians prior to military deployment or international humanitarian efforts and to create toxicology clinical There is no prior publication, conflict of interest, or copyright constraint. Th...

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Resource-Use Analysis of a Medical Toxicology Consultation Service

Cited by 17 publications

References 3 publications

Effect of a Medical Toxicology Admitting Service on Length of Stay, Cost, and Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses

Effect of a Medical Toxicology Admitting Service on Length of Stay, Cost, and Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses

The Feasibility and Acceptability of Google Glass for Teletoxicology Consults

Wartime Toxicology: Evaluation of a Military Medical Toxicology Telemedicine Consults Service to Assist Physicians Serving Overseas and in Combat (2005–2012)

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