The association between U.S. Poison Center assistance and length of stay and hospital charges

Abstract

Context. Poison centers (PCs) play an important role in poison prevention and treatment. Studies show that PCs reduce system-wide cost by reducing the number of unnecessary visits to emergency departments and by providing improved patient management. However, there remains a debate regarding the impact of PCs on patient outcomes at the hospital level. Objective. To evaluate the impact of PC involvement on length of hospitalization and total hospital charges. Materials and methods. We conducted a retrospective analysis of inpatient cases treated in Illinois hospitals in 2010. We linked the Illinois Poison Center database with an Illinois hospital billing dataset and controlled for important patient-level and facility-level covariates. Results. In the multivariable model, length of hospitalization among PC-assisted patients was 0.58 days shorter than that of patients without PC assistance (p < 0.001). Hospital charges for PC-assisted patients in the lower quintiles were significantly higher than patients without PC assistance (+$953; p < 0.001), but were substantially lower in the most costly quintile of patients (−$4852; p < 0.001). Balancing the higher charges for treating patients with PC assistance in the lower quintiles with the savings in the highest quintile, among inpatients there is a potential cumulative decrease of $2,078 in hospital charges per 10 patients. Discussion. Among the inpatient cases, PC assistance was associated with lower total charges only among the most expensive to treat. However, this outlier group is very important when discussing medical costs. It has been repeatedly shown that the majority of treatment costs are attributable to a small fraction of patients as seen in this study.

Keywords:

• Poisoning
• Poison control center
• Hospital charges
• Length of stay

Authorship

Dr. Lee Friedman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Lee Friedman was involved in the conception and design, acquisition of data, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content and statistical expertise. Alison Krajewski was involved in the conception and design of the data linkage methods, analysis and interpretation of the data, drafting of the article, and statistical expertise. Ember Vannoy was involved in the conception and design, and development of the data linkage methodology. Amy Allegretti was involved in the conception and design, analysis and interpretation of the data. Mike Wahl was involved in the acquisition of data and critical revision of the article for important intellectual content.

Funding: No funding was solicited or received for this study.

Declaration of interest

LSF provides consulting services to the Illinois Poison Center related to real-time surveillance and education outreach. MW is Director of the Illinois Poison Center. None of the other authors have any conflicts of interest that may be relevant to the submitted work.