Alternative Models for Telephone Response to Pediatric Poisonings

Abstract

Background. Poison Control Centers (PCCs) provide telephone consultations to manage poisonings. They are threatened with funding loss. Policy decision-makers have requested an evaluation of alternate models for telephone management of poisonings. Objective. We examined the feasibility of alternative models for the telephone management of poisonings from the public. Methods. Alternative models evaluated included emergency medical dispatchers (EMDs), advice nurses (RNs), andpoison information providers (PIPs) to manage real andhypothetical poisonings with protocols or computerized references (Poisindex®) with andwithout PCC backup. Results. EMDs andRNs with a structured protocol andaccess to a PCC specialist were able to manage a small subset of poisoning calls. EMDs andRNs managed 6% and12% of poisoning calls respectively. Non-protocol management of hypothetical cases using Poisindex® resulted in mismanagement of cases andlonger periods of time to manage cases. PIPs within a PCC were able to manage a substantially greater proportion of calls, but had a significant portion of non-productive time waiting for a PCC call. Conclusion. EMDs, RNs, andtechnician-level PIPs can manage a subset of poisoning cases using structured protocols. Alternative providers were dependent on PCC staff for consultation of the majority of poisoning calls. There are several obstacles to these models andtheir cost-effectiveness needs to be determined. These studies were the basis of a new staffing model with the integration of PIPs into the call response system in California.

Key words:

• poisoning
• telephone hotline
• poison control center
• patient care management