Introduction Morbidity and mortality from poison-and drug-related illness continue to rise in the USA. Medical toxicologists are specifically trained to diagnose and manage these patients. Inpatient medical toxicology services exist but their value-based economic benefits are not well established. Methods This was a retrospective study where length of stay (LOS) and payments received between a hospital with an inpatient medical toxicology service (TOX) and a similar hospital in close geographic proximity that does not have an inpatient toxicology service (NONTOX) were compared. Controlling for zip code, demographics and distance patients lived from each hospital, we used a fitted multivariate linear regression model to identify factors associated with changes in LOS and payment. Results Patients admitted to the TOX center had 0.87 days shorter LOS per encounter and the hospital received an average of $1800 more per patient encounter. Conclusion In this study, the presence of an inpatient medical toxicology service was associated with decreased patient LOS and increased reimbursement for admitted patients. Differences may be attributable to improved direct patient care provided by medical toxicologists, but future prospective studies are needed.

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Introduction: Prior to the diagnosis of the first SARS-CoV2 patient in Florida, the Miami Dade Fire Rescue developed and implemented its return-to-work protocol based on guidelines from the CDC and Florida Fire Chiefs Association. As of February 17, 2020, all asymptomatic employees exposed to PCR-confirmed positive SARS-CoV2 individuals would be excluded from work for 14 days and report absence of symptoms to a delegated supervisor every 24 hours. We postulated that if COVID-19 transmission rate continues at the current rate in the absence of systemic vaccination strategy for SARS-CoV2, then a safer and more efficient return-to-work policy is needed for exposed first responders who are identified as low-risk for disease transmission. Objectives: We sought to establish a safe and shortened return-to-work protocol to maintain our workforce. We evaluated the utility of serological antibody testing in predicting negative seroconversion of first responders at 7 days post low-risk exposure to confirmed COVID-19 individuals. Methods: All exposed, asymptomatic employees underwent serology testing for SARS-CoV2 one week after the initial exposure. Participants who were serologically negative had follow-up RT-PCR within 24 hours and serology testing 14 days after the initial serological test. Results: Overall, of the 71 firefighters who have had documented exposures to SARS-CoV2 positive individuals in the fire rescue agency, 41 of 71 had initially negative serology studies. Of the 41 patients with negative serology studies, 20 voluntarily underwent confirmatory PCR testing within one day after serology testing and all 20 participants were negative. Subsequently, out of the 20 participants who underwent serology and PCR testing, 10 participants followed up and underwent repeat serology testing 14 days after exposure and all 10 participants had negative repeat serology tests. The other ten who chose not to retest remained asymptomatic 14 days after exposure. Conclusions: Although serology testing has limitations, it correlated with negative prediction of disease in low-risk participants with exposures in this study. Serology testing may offer a feasible, alternative return-to-work strategy for fire agencies. Keywords: COVID-19, SARS-CoV-2, Rapid IgM-IgG Combined test, Point-of-Care Testing, Return-to-Work protocol