Hospital referrals of patients with acute poisoning by the Belgian Poison Centre: analysis of characteristics, associated factors, compliance and costs.

OBJECTIVE: Aims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2) to assess the compliance and potential health-economic impact. METHODS: Three types of referrals to the hospital of patients who called the BPC between 1 January and 30 June 2018 were analysed: referrals in case of deterioration in the patient's condition (Hosp-watchful-wait), referrals (Hosp-referral) or urgent referrals (Hosp-urgent-referral). Factors associated with type of recommendation were registered. A survey was conducted on a second dataset of patients who called the BPC between 1 March and 15 May 2019 and referred (conditionally) to the hospital. RESULTS: 5476 referrals were included: 72.4% accidental poisoning, 25.3% intentional self-harm, 1.2% substance abuse and 1.1% unclear intentionality. There were 2368 (43.2%) Hosp-watchful-wait cases, 2677 (48.9%) Hosp-referrals and 431 (7.9%) Hosp-urgent-referrals. In Hosp-watchful-wait cases, soaps and detergents were represented most (20.5%). In Hosp-referrals and Hosp-urgent-referrals, benzodiazepines (12.7% and 15.1%, respectively) predominated. Factors associated with hospitalisation type were number of symptoms, intentionality, type of agent(s) involved and advising antidotes. The survey showed that 7.8% of Hosp-watchful-wait patients went to the hospital versus 57.3% of Hosp-referrals and 59.6% of Hosp-urgent-referrals. The mean cost for Hosp-watchful-wait patients, Hosp-referrals and Hosp-urgent-referrals was estimated at €127, €767 and €796, respectively. CONCLUSION: Only a small proportion of patients followed the advice of the BPC to go (conditionally) to the hospital. A systematic follow-up of cases is warranted to examine the appropriateness of referrals and the compliance of patients.

Health care cost savings from Australian Poisons Information Centre advice for low risk exposure calls: SNAPSHOT 2.

Introduction: To estimate cost savings from the Australian Poisons Information Centres (PIC) through reductions in unnecessary health resources following unintentional low toxicity poisonings.Methods: Two telephone surveys were conducted. The first to PIC callers over a one-week period about unintentional exposures where the callers' alternate course of action in the hypothetical situation in which the PIC did not exist was questioned. The second survey to determine the proportion of callers followed PIC advice. We estimated cost savings associated with instances where individuals acted on advice not to present to hospital, when they indicated they would have otherwise as well as savings from preventing unnecessarily utilisation of medical resources. Database records of unintentional poisonings from all Australian PICs for 2017 were used.Results: A total of 958 consecutive callers were surveyed. PIC advised 91% of callers to stay at home, remaining callers were referred to hospital (5%), to their GP (3%) or given other recommended management advice (1%). PIC advice was followed by 97.6% of callers. In PIC absence, 22% of callers who were advised to stay home would have presented to hospital (3% via ambulance), 8% would visit their General Practitioner (GP) and only 9% would stay at home. In 2017, PICs were called about 94,913 unintentional poisonings; and PICs generated at least $10.1 million in annual savings.Conclusion: In 2017, PICs provided at least a three-fold return on investment for every dollar invested, demonstrating that PICs are a highly cost effective service.

Belgian Poison Centre impact on healthcare expenses of unintentional poisonings: a cost-benefit analysis.

OBJECTIVES: This study evaluates the impact of the Belgian Poison Centre (BPC) on national healthcare expenses for calls from the public for unintentional poisonings. METHODS: The probability of either calling the BPC, consulting a general practitioner (GP) or consulting an emergency department (ED) was examined in a telephone survey (February-March 2016). Callers were asked what they would have done in case of unavailability of the BPC. The proportion and cost for ED-ambulatory care, ED 24-h observation or hospitalisation were calculated from individual invoices. A cost-benefit analysis was performed. RESULTS: Unintentional cases (n = 485) from 1045 calls to the BPC were included. After having called the BPC, 92.1% did not seek further medical help, 4.2% consulted a GP and 3.7% went to an ED. In the absence of the BPC, 13.8% would not have sought any further help, 49.3% would have consulted a GP and 36.9% would have gone to the hospital. The cost-benefit ratio of the availability of the BPC as versus its absence was estimated at 5.70. CONCLUSIONS: Financial savings can be made if people first call the BPC for unintentional poisonings.

The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis.

OBJECTIVE: The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. METHODS: A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. RESULTS: Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. CONCLUSIONS: Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers.

Impact of the Use of Regional Poison Control Centers in an Urban EMS Dispatch System.

BACKGROUND: The public commonly calls 911 for unintentional ingestions, rather than calling the local poison center. By utilizing a series of scripted questions, 911 dispatchers in Los Angeles determine if an ingestion meets "omega-1" classification. Under such circumstances, the regional poison center is contacted prior to dispatch of paramedics. If the poison center advises that the patient can remain at home, EMS is not dispatched and the patient is followed at home by the poison center. The primary objective is to determine the number of averted transports through involvement of a poison center. A secondary objective is to determine the potential costs and charges saved with the use of such a strategy. METHODS: A retrospective review of all overdose calls with an "omega-1" classification to a single EMS system between 1/2008-6/2012. Each call culminating in an EMS dispatch was subsequently reviewed by two additional reviewers. The cost savings was determined by utilizing data from the Medical Expenditure Panel Survey (MEPS) from 2000 to 2010. Monetary values were adjusted to 2012 dollars. RESULTS: Three hundred eighteen cases received "omega-1" dispatch classification. EMS was dispatched 19 times (5.98 %), and 11 patients (3.46 %) were ultimately transported. The most common reasons for transport were ambiguity over the ingested agent or amount, and caller insistence. Using these estimates, routine consultation of a regional poison center as part of EMS dispatch averted $486,595 in charges, and $183,279 in payments. CONCLUSIONS: Routine consultation of a poison center by emergency medical dispatchers can reduce unnecessary dispatches, ambulance transports, and ED visits with significant associated cost savings.

Poisoning in the United States: 2012 emergency medicine report of the National Poison Data System.

Deaths from drug overdose have become the leading cause of injury death in the United States, where the poison center system is available to provide real-time advice and collect data about a variety of poisonings. In 2012, emergency medical providers were confronted with new poisonings, such as bath salts (substituted cathinones) and Spice (synthetic cannabinoid drugs), as well as continued trends in established poisonings such as from prescription opioids. This article addresses current trends in opioid poisonings; new substances implicated in poisoning cases, including unit-dose laundry detergents, bath salts, Spice, and energy drinks; and the role of poison centers in public health emergencies such as the Fukushima radiation incident.

Canadian poison control centres: preliminary assessment of their potential as a resource for public health surveillance.

CONTEXT: In the United States (US) and Europe, surveillance based on calls to poison control centres has identified new hazards and evolving exposure trends. In Canada, the value of poison control centre calls as a tool for health hazard surveillance is largely unrecognized. OBJECTIVES: This preliminary survey was undertaken to describe current operational characteristics and surveillance capacities at Canadian poison control centres and to determine potential for developing a Canadian poison control centre collaborative network. METHODS: A structured quantitative-qualitative survey was administered to medical directors and clinical supervisors at the five Canadian poison control centres between March and May, 2012. RESULTS: All five Canadian poison control centres operate 24/7 with each serving more than one province/territory. Annual call volumes range from 10,000 to 58,000. Data analysis is limited to detection of previously unrecognized hazards and short-term event-based adverse health monitoring. Currently no centre maintains systematic ongoing collection, integration and analysis of data. Constraints on personnel, resources and funding were identified as barriers to increasing capacity to provide and analyse call data. CONCLUSIONS: The potential exists to use Canadian poison control data as a novel source of public health surveillance. That they serve as sentinels for new or unexpected exposure events, have real-time electronic call-record capacity and demonstrate an interest in developing and sharing their call-record information supports their integration into existing public health networks.

Economic evaluation of poison centers: a systematic review.

OBJECTIVES: The aim of this study was to summarize and assess economic evaluations of poison centers (PCs) from the perspectives of society, the payer, and the healthcare system. METHODS: A systematic review was performed to identify complete economic evaluations regardless of the language or publication status. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. RESULTS: In total, 422 non-duplicated studies were retrieved, but only nine met the eligibility criteria. Five of the eligible studies were published in the 1990s, and four were published in the 2000s. Six studies met at least seven of ten quality criteria. In all studies, the presence of PCs was compared with a scenario of their absence. Eight studies used cost-benefit analyses and one used a cost-effectiveness approach. The cost-benefit ratios ranged from 0.76 to 7.67, which indicates that each United States dollar (USD) spent on poison centers can save almost 8 USD on medical spending. A cost-effectiveness analysis showed that each successful outcome achieved by a PC avoids a minimum of 12,000 USD to 56,000 USD in other healthcare spending. CONCLUSIONS: The data in our review show that PCs are economically viable. PCs improve the efficiency of healthcare expenditure and contribute to the sustainability of the healthcare system. An investment in PCs is a rational public health policy approach that contrasts the current trend of reducing spending on PCs.

Establishment and first experiences of the National Serum Depot in the Netherlands.

Since 2008, a National Serum Depot is operational in the Netherlands, guaranteeing antivenom supply, 24 h per day, during medical emergencies. In this article the organisation structure, choice of antivenoms, problems encountered during the establishment, and the results from establishment in 2008 till December 2011 are discussed. The Serum Depot is organised by the National Institute for Public Health and the Environment in cooperation with the Dutch National Poisons Information Center. During establishing and maintaining of the Serum Depot several antivenom purchase difficulties were encountered. Some antivenom producers did not respond upon (initial) contact and some antivenoms were (temporarily) unavailable. Good contacts with professional herpetologists are necessary in order to keep the content of the depot up-to-date. At the same time, it is important to remain well informed concerning the safety and efficacy of the currently available antivenoms and development of new antivenoms. During the first four years of the National Serum Depot, the Dutch National Poisons Information Center was consulted on average 10 times a year about exotic venomous bites and stings in which antivenom treatment might play a role. Almost half of these consultations were related to bites by venomous exotic snakes, the other half to scorpion and fish stings. Antivenom was delivered in five cases, all after a bite by an exotic venomous snake, and actually administered twice because of the severity of local effects. To reduce costs and extend coverage of the Serum Depot of antivenoms for more unfamiliar snake species, international cooperation between the various owners of the antivenom Serum Depots in Europe is recommended.

Preserving the United States's poison control system.

The funding of United States's poison control centers is threatened. The following Commentary argues for support of the current outstanding poison control system by presenting the evidence for its cost-effectiveness.

Budget cuts and U.S. Poison Centers - regional challenges create a nationwide problem.

Federal funding of poison centers (PCs) in the United States was established in 2000 through the Poison Control Center Enhancement and Awareness Act. Unfortunately, the problems with financial stability of PCs that this legislation was intended to improve persist because of continued reliance on fragile local funding sources. In the past few months budget cuts have had an impact on PC activity and threaten the continued existence of a nationwide network of PCs in the United States. This commentary discusses the problems faced by PCs in this changing environment and illustrates the many competing tasks that the PC network performs for the U.S. population. PCs face continuing challenges in coming months and a unified approach at a national level may provide the best opportunity for a solution to this crisis.

The National Poison Center in Norway: user satisfaction and a health economic evaluation.

OBJECTIVES: The aim of the study was to find out how satisfied users are with the National Poison Center of Norway and to make a health economic evaluation of the service. METHOD: The material consisted of telephone interviews with 310 users of the service from the general public and 665 completed questionnaires from doctors and nurses. RESULTS: Most respondents were satisfied with the information and had followed the advice. They also felt safer after making a phone call. It was found that the running costs of the Poison Center are approximately the same as the estimated additional costs the health care system would incur if the service did not exist. CONCLUSIONS: Both users and health care personnel are highly satisfied with the Poison Center hotline. Even though the Norwegian health system does not necessarily save money by providing the service, the safety it provides cannot be measured in economic terms.

The use of an automated interactive voice response system to manage medication identification calls to a poison center.

INTRODUCTION: In 2007, medication identification requests (MIRs) accounted for 26.2% of all calls to U.S. poison centers. MIRs are documented with minimal information, but they still require an inordinate amount of work by specialists in poison information (SPI). An analysis was undertaken to identify options to reduce the impact of MIRs on both human and financial resources. METHODS: All MIRs (2003-2007) to a certified regional poison information center were analyzed to determine call patterns and staffing. The data were used to justify an efficient and cost-effective solution. RESULTS: MIRs represented 42.3% of the 2007 call volume. Optimal staffing would require hiring an additional four full-time equivalent SPI. An interactive voice response (IVR) system was developed to respond to the MIRs. DISCUSSION: The IVR was used to develop the Medication Identification System that allowed the diversion of up to 50% of the MIRs, enhancing surge capacity and allowing specialists to address the more emergent poison exposure calls. This technology is an entirely voice-activated response call management system that collects zip code, age, gender and drug data and stores all responses as .csv files for reporting purposes. The query bank includes the 200 most common MIRs, and the system features text-to-voice synthesis that allows easy modification of the drug identification menu. Callers always have the option of engaging a SPI at any time during the IVR call flow. CONCLUSIONS: The IVR is an efficient and effective alternative that creates better staff utilization.

Poison control centers decrease emergency healthcare utilization costs.

INTRODUCTION: Patient home management by a regional poison control center has potential to save public healthcare dollars by preventing unnecessary utilization of emergency department services. We wished to conservatively quantify such savings at a large regional poison center and compare savings to funds received in state support. METHODS: Banner Poison Control Center (BPCC) serves a population of about four million in central AZ. A telephone survey of callers who were managed at home in February and March of 2007 after nontoxic exposures was used to calculate what percentage of such callers would have sought unnecessary medical care in emergency departments. Twelve emergency departments geographically dispersed in the region were surveyed, and a state database of hospital charges was queried to determine hospital charges and physician professional charges for conservative management of a patient who would have been advised to remain at home by BPCC. RESULTS: BPCC managed 28,883 callers at home in 2007. Seventy percent of home-managed patients would have sought unnecessary care in emergency departments. Using most conservative assumptions, a median of $33 million [range $18 million to $45 million] in unnecessary health care charges were prevented by BPCC home-management in 2007. A median of about $36 in unnecessary health care charges were prevented for each dollar of state funding BPCC received. CONCLUSIONS: Home management by BPCC provides large dollar savings to residents compared to dollars received in state support.

Poisoning hospitalization correlates with poison center call frequency.

INTRODUCTION: Poison Control Centers (PCCs) have been shown to reduce health expenditures by reducing emergency department and clinic visits. The effect or association of PCC call frequency on acute hospitalization rates for poisonings has not been studied extensively. METHODS: All nonfederal hospital discharges for acute poisoning principal diagnosis codes (960-979, 980-989, 9956X, 3030, and 005) in California between October 1999 and June 2002 were examined. Approximately 3.3% of the discharges had county/hospital information suppressed in the public-use database because of confidentiality criteria and were excluded from the analysis. U.S. Census Bureau population estimates for appropriate years by counties were also obtained. The 58 California counties were condensed to 48 counties and 3 "small-county" geographic groupings. Exposure calls by counties/groupings to the California Poison Control System(CPCS) for the same period were tabulated. RESULTS: In California, rates of hospital discharges for poisoning averaged 0.54/1000 person years with a range of 0.25/1000 person years (Central Counties) to 1.53/1000 person years (Del Norte County). Poison call rates averaged 8.5/1000 person years with a range of 4.9/1000 person years (Los Angeles County) to 19.6/1000 person years (Napa County). Poisoning discharges per 1000 person years positively correlated with PCC calls per 1000 person years (Spearman correlation 0.41, p = 0.0003). The average hospital length of stay (LOS) did not correlate with PCC call frequency or poisoning discharges per 1000 person years. CONCLUSION: The CPCS call frequency or county penetrance was not correlated with a reduction in the number of hospitalizations for poisoning nor was it associated with reduced average LOS in this study. Further study is needed to understand the etiology of the large differences in county rates of poisoning hospitalization and average LOS.

Cost-benefit analysis of a regional poison center.

BACKGROUND: Funding poison center (PC) operations has become a major challenge nationwide. Increasingly, state and federal budget cuts have resulted in diminished funding to PCs. OBJECTIVES: In an effort to demonstrate the value of current PC phone services, a cost-benefit analysis of a regional center was completed. METHODS: A telephone survey was used to collect data from PC callers during an 8-week period in 2004. Callers with human exposure poisonings determined by the PC to be of minimal or no risk were asked to complete the phone survey. Callers were asked their alternative plan if the PC staff had not been available to assist them. Benefits were measured as healthcare charges potentially avoided. RESULTS: A total of 652 caller surveys were completed. The benefit-to-cost ratio was 7.67 (95% C.I. 6.83, 8.50). CONCLUSION: In addition to non-monetary benefits, the operation of a regional poison center provides significant positive return on investment.