Downes MA, Balshaw JK, Muscat TM, Ritchie N, Isbister GK. Am. J. Emerg. Med. 2017; 35(5): 764-768.
Affiliation
Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, NSW, Australia; Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia.
OBJECTIVES: This was a before and after study which sought to assess the impact of opening an ED short stay unit (ESSU) on the ED performance of poisoned patients.
METHODS: Data was collected from two groups of adult patients presenting to an ED with a tertiary referral inpatient Toxicology unit from the 2009 and 2012 calendar years, to assess the impact of the ESSU. The toxicology unit clinical database and hospital electronic medical records were interrogated for demographic, clinical and hospital flow details of presentations. The primary outcome was ED length of stay (LOS). Other outcomes included proportion of patients remaining in ED for their admission, 28day re-presentations and hospital LOS.
RESULTS: During 2009, 795 patients met inclusion criteria, and during 2012, 762. The median LOS in ED was reduced from 8.5 h (IQR: 4.7-14 h) to 2.7 h (IQR: 1.6-4.6; p<0.0001). The proportion of patients remaining in ED for their entire hospital stay was reduced from 515/795 (65%) to 56/762 (7.3%) [Absolute difference: 57%; 95% CI: 53 to 62%; p<0.0001]. Total hospital LOS increased from 14.5 h (IQR: 8.4-21.8 h) to 16.7 h (IQR: 11.5-23; p<0.0001), but there was a decrease in re-presentations with self-poisoning within 28days from 6.9% in 2009 to 4.5% in 2012 (p<0.038). There was no difference between disposition destination or toxins causing exposure between the two groups.
CONCLUSIONS: The ESSU led to a significant improvement in ED performance of poisoned patients. It also potentially assisted in reducing ED overcrowding.