Development and Implementation of An Emergency Department Observation Unit Protocol for Deliberate Drug Ingestion in Adults – Preliminary Results

Abstract

Background. Patients presenting after reported overdose are typically precluded from admission to emergency department observation units (EDOU). The purpose of this study was to describe the initial experience with an EDOU overdose protocol. Methods. Retrospective chart review of all individuals presenting to a tertiary care hospital with a chief complaint of overdose or intoxication for the period 7/1/2004 through 12/24/2004. Inclusion criteria for EDOU placement included asymptomatic patients aged ≥ 15 years presenting after known or suspected potentially toxic exposure. Exclusion criteria included isolated ethanol intoxication, presence of persistent self-injurious or violent behaviors, chronic intoxication, ingestion of sustained release preparation, and presence of previously defined high-risk criteria. Results. Retrospective chart review demonstrated that 163 patients presented to the ED after ingestion during this time period, of which 15 were excluded secondary to age. Six patients were admitted to the EDOU. No patient eloped or attempted further self-harm while in the EDOU. No clinical decompensation occurred. Another 27 patients were retrospectively identified as EDOU candidates, eight of whom were admitted to the MICU. Conclusion. Although initial numbers are too small for meaningful analysis, the results suggest that prolonged observation of this problematic patient subset within an EDOU is feasible.

Keywords :

• Observation Medicine
• Overdose
• Ingestion
• Adult

Notes

*Portions of this article were presented at the North American Congress of Clinical Toxicology, Orlando, FL, September, 2005.