The impact of the introduction of a toxicology service on the intensive care unit

Parish, Shaun, Carter, Angus, Liu, Yu-Hsuan, Humble, Ian, Trott, Nicholas, Jacups, Susan, and Little, Mark (2019) The impact of the introduction of a toxicology service on the intensive care unit. Clinical Toxicology, 57 (9). pp. 778-783.

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Objective: To examine the impact of a clinical toxicology service on toxicology patients admitted to an intensive care department

Methods: The authors performed a retrospective chart audit of all patients presenting to Cairns Emergency Department (ED) over a five-year period from 2011 to 2016 with a toxicology diagnosis requiring Intensive Care Unit (ICU) admission. They were divided into two groups: pre-toxicology (1 April 2011 to 30 September 2012), and post-toxicology service (1 October 2012 to 31 of March 2016) introduction. Patients were identified using ED and ICU databases. Patient charts were manually searched, and data entered on a preformatted data extraction tool. The data were statistically compared pre- versus post-toxicology service introduction using univariate (t-tests and Pearson’s Chi Square) and multivariate modelling. Where appropriate, continuous variables were log transformed to enable parametric analyses.

Results: There were 37 patients in the pre-toxicology and 102 in the post-toxicology group, with an increased median APACHE III J score in the post toxicology group (39 vs. 49). The introduction of a toxicology service was associated with statistically significant reductions in median ICU length of stay (LOS) (32.9 vs. 20.6 h), median duration of mechanical ventilation (29.1 vs. 20.6 h) and median time to psychiatry review (19.4 vs. 6.7 h). The reduction in ICU LOS remained statistically significant (p = 0.036) when adjusted by sex, age and duration of mechanical ventilation. There was neither increase in mortality, nor readmissions from EDSSU to ICU.

Conclusions: This study has demonstrated that the introduction of a toxicology service was associated with a reduction in median ICU LOS, duration of mechanical ventilation and time to psychiatric review in patients with a toxicology diagnosis admitted to our ICU.

Item ID: 57395
Item Type: Article (Research - C1)
ISSN: 1556-9519
Keywords: intensive care, length of stay, mechanical ventilation, toxicology
Copyright Information: Copyright © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Date Deposited: 28 Mar 2019 04:21
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3214 Pharmacology and pharmaceutical sciences > 321407 Toxicology (incl. clinical toxicology) @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 100%
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