The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

Improving Communication Skill Competency in the Emergency Department through Role Play and Direct Observation

PURPOSE: Good communication between patient and medical staff in an emergency department (ED) fosters patient satisfaction and improves healthcare outcomes. Assessment and implementation of training is key in providing better patient care. The purpose of this study is to evaluate the effect of providing communication skills training to ED physicians and nurses using problem identification, role playing and direct observation. METHODS: The ED faculty in collaboration with an external communications expert group developed a communication skills training manual. The training group participated in simulated patient scenarios followed by video feedback and debriefing sessions. The participants were assessed on their communication skills while delivering care to live patients in real clinical situations before and after the training. The communication skills of the training group were compared with those of the control group. RESULTS: A total of 28 residents and nurses from two departments were enrolled in this study. Pre- to post-training scores (scale 1-5) for the training group improved from 3.0 [2.8, 3.9] to 3.9 [3.1, 4.3] (p=0.025). However, the pre- and post-score difference between the training and control groups was not statistically significant. CONCLUSION: Role play training has been found to be effective in improving communication skills. However, future research is required to develop a more effective training method and determine how to facilitate training implementation in complex clinical healthcare settings, such as the ED.

Comparison between Emergency Patient Poisoning Cases and the Tox-Info System Database

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.