Use of a 23-hour emergency department observation unit for the management of patients with toxic exposures

• Published in: Emergency medicine journal : EMJ Vol. 34; no. 11; pp. 755 - 760
• Main Authors: Mong, Rupeng, Arciaga, Gabriel Joseph, Tan, Hock Heng
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2017
• Subjects: Adult; Anaphylaxis - etiology; Anaphylaxis - prevention & control; Coma; Drug overdose; Emergency medical care; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - utilization; Environmental Exposure - adverse effects; Female; Hospitals; Humans; Insect Bites and Stings - therapy; Length of Stay - statistics & numerical data; Male; Observation - methods; Patients; Poisoning; Poisoning - therapy; Poisons; Retrospective Studies; Severity of Illness Index; Singapore; Time Factors; Toxicology; Trends; Vital signs; Singapore; poisoning; emergency department
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emermed-2016-206531

BackgroundA significant proportion of patients with toxic exposures presenting to the ED require admission. However, most will improve within 24 hours, and so could potentially be managed in a short-stay observation unit. We describe the management and outcomes of these patients in a 23-hour ED observation unit (EDOU).MethodsA retrospective chart review of all patients with toxic exposures admitted to the EDOU in Singapore between 1 April 2013 and 31 March 2015 was performed. Patient demographics, exposure patterns, clinical presentation and interventions received were abstracted. The poisoning severity score (PSS) was retrospectively determined. Outcomes were length of stay and disposition.ResultsA total of 286 patients were analysed, of which 78.0% had intentional self-poisoning, 12.2% had bites/stings and 9.8% had unintentional or occupational toxic exposures. Analgesics (29.4%), sedatives (12.3%) and antidepressants (6.8%) were the most common drugs encountered. The majority of patients had a mild (68.9%) or moderate (15.4%) PSS, but 4.2% were graded as severe. Most patients with deliberate self-poisoning were reviewed by psychiatry (88.8%) and social services (74.9%). Most patients (92.0%) were medically cleared during their stay in EDOU, including all 12 with a severe PSS. Of these, 200 (69.9%) were discharged and 63 (22.0%) were transferred directly to a psychiatric unit. The median length of stay in the EDOU was 18 hours (IQR 13–23).ConclusionMost patients admitted to the EDOU were successfully managed and medically cleared within 23 hours, including those with a severe PSS. The EDOU appears to be a suitable alternative to inpatient admission for selected patients.