Reductions in emergency department visits after primary healthcare use of the UK National Poisons Information Service

Abstract

Background: Suspected poisoning is a common cause of hospital admission internationally. In the United Kingdom, the National Poisons Information Service (NPIS), a network of four poisons units, provides specialist advice to health professionals on the management of poisoning by telephone and via its online poisoning information and management database, TOXBASE^®.

Objective: To demonstrate the impact of NPIS telephone advice and TOXBASE^® guidance on poisoning-related referrals to emergency departments (ED) from primary healthcare settings.

Methods: A telephone survey of primary healthcare providers calling the NPIS and an online survey of TOXBASE^® primary care users were conducted to evaluate the effect of these services on poisoning-related ED referrals. Enquirers were asked to indicate whether referral was needed before and after using these information sources.

Results: The number of cases considered by enquirers appropriate for ED referral was reduced from 1178 (58.1%) before to 819 (40.4%) after the provision of telephone advice for 2028 cases (absolute reduction 17.7%, 95% CI 14.6, 20.7%) and from 410 (48.2%) before to 341 (40.1%) after consideration of TOXBASE^® guidance for 851 cases (absolute reduction 8.1%, 95% CI 3.3, 12.9%). By extrapolating these figures over a full year, it is estimated that these services prevent approximately 41,000 ED referrals annually.

Conclusions: The use of NPIS services significantly reduced ED referrals from primary healthcare services with resulting avoided healthcare costs exceeding the current annual NPIS budget. Further studies are needed to evaluate other potential benefits of accessing NPIS services.

Keywords:

• Poisoning
• hospital presentations
• emergency departments

Disclosure statement

No potential conflict of interest was reported by the authors. The authors are all employed by National Health Service Trusts or Boards that are commissioned by Public Health England to provide poisons information services.