The Impact of an Emergency Department Toxicology Team in the Management of Acute Intoxication

Chung, Ahy; Tsui, S. L.; Tong, HK

doi:10.1177/102490790701400302

Cited by 12 publications

(17 citation statements)

References 8 publications

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“…There was no cost saving calculated. Units overseas have also shown similar reductions in the average LOS …”

Section: Introductionmentioning

confidence: 66%

“…Units overseas have also shown similar reductions in the average LOS. 5,6 A dedicated clinical toxicology unit (CTU) was formally established with admission rights to the Princess Alexandra Hospital (PAH) being granted in February 2014 after a transitional period during 2013. The aim of the unit is to coordinate and improve the quality of care of the toxicological patient by providing 24/7 consultation and inpatient management for patients who have been poisoned or envenomed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Isoardi

Armitage

Harris

et al. 2017

Emerg Medicine Australasia

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“…There was no cost saving calculated. Units overseas have also shown similar reductions in the average LOS …”

Section: Introductionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

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

Isoardi

Armitage

Harris

et al. 2017

Emerg Medicine Australasia

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“…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%

“…Four articles reported specifically on this outcome. Two of the articles reported no change in mortality after initiation of inpatient toxicology services , and one article reported no change in patient outcomes and no change in ED re‐attendance or hospital admission . However, one article (that contemporaneously compared between sites and teams) reported that patients managed at a specialist centre by an inpatient toxicology team had a lower mortality than expected, by up to 5.48%, significantly more than other cohorts .…”

Section: Resultsmentioning

confidence: 98%

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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“…This model of care improves patient outcome and shortens the length of stay for medical treatment. 6,7 Such improvements might explain the observed good outcome for Chan et al's cohort 4 of patients with paracetamol overdose.…”

mentioning

confidence: 95%

Management of acute paracetamol poisoning

Tsui

2015

Hong Kong Med J

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Since 2010, paracetamol has been the most common agent used in Hong Kong for deliberate self-harm by overdose and poisoning.1 It is readily available over-the-counter and is commonly prescribed by doctors. There are more than 900 registered pharmaceuticals that contain paracetamol in Hong Kong. Paracetamol overdose can result in delayed, sometimes life-threatening, liver injury and dosedependent damage. N-acetylcysteine (NAC) is well known to be an effective antidote that can prevent liver injury if administered in time. The decision to give NAC can be facilitated by plotting the serum paracetamol concentration against time since ingestion on the Rumack-Matthew nomogram. In the article written by Chan et al, 4 the 150-treatment line has been evaluated and identified a failure rate of 0.45%. All four index patients developed chemical hepatitis that responded to supportive treatment. The incidence of 150-treatment line failures in the US has been reported as 1% to 3% and thought to be predominantly due to inaccurate ingestion history.5 Looking closely at the four cases presented in Chan et al's study, 4 two of them presented late, and in most cases there was an apparent discrepancy between the dose taken and the achieved paracetamol level. Similar to the US experience, an inaccurate ingestion history might explain treatment-line failure for some of these cases. Further evidence from more robust studies is needed before a recommendation can be made to lower the treatment threshold to the UK standard. Obtaining an accurate history from patients who deliberately self-harm is known to be difficult. Patients may be unwilling or unable to provide accurate information to the clinician. According to the author's own experience in managing such patients, history taking must be done tactfully and sometimes repeatedly from different sources of information. An astute physician should make the decision to give NAC after analysing all the available evidence including the best-gathered history, the clinical presentation, and the remaining treatmenttime window, together with the serum paracetamol level. Laboratory tests may help but can never replace clinical skill, clinical judgement, and experience in patient management.Previously, the responsibility for managing such time-critical overdosed patients was often borne by interns and junior residents. The quality of care provided may not have been optimal. Over the past 10 years emergency physicians and trainees have received intensive training in the management of toxicology cases based on updated evidence and standards. In addition, groups of interested emergency physicians have formed toxicology teams to oversee and support the management of poisoning patients in individual hospitals. This model of care improves patient outcome and shortens the length of stay for medical treatment.6,7 Such improvements might explain the observed good outcome for Chan et al's cohort 4 of patients with paracetamol overdose.

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The Impact of an Emergency Department Toxicology Team in the Management of Acute Intoxication

Cited by 12 publications

References 8 publications

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

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

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

Management of acute paracetamol poisoning

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