Abstract |
Objective: To describe the development and activity
of a multidisciplinary service to manage self poisoning in terms of
service structure, philosophy, outcomes and resource use.
Design: Descriptive, comparative study with
prospective data collection.
Setting: Regional toxicology treatment centre in
the Hunter Area of New South Wales (NSW) with primary and secondary
referral service to 385,000 and tertiary referral service to
100,000.
Patients: All patients (1987-1995) with poisoning
or envenomation presenting to the Hunter Area Toxicology Service
(HATS).
Main outcome measures: Average length of stay (ALOS)
for HATS compared with national and NSW hospitals. Mortality data for
HATS compared with NSW.
Results: ALOS for HATS was 0.53-1.22 days shorter
than for all Australian hospitals, potentially saving 518 bed days
valued at $468,000 per year. ALOS was 0.94-3.39 days shorter than for
all NSW hospitals; 1,470 bed days at $1.4 million per year. Inpatient
mortality (0.2%; 95%CI 0.0-1.1) was not significantly different
from NSW (0.5%; 95%CI 0.2-0.8). Standardised mortality ratios
showed no greater all cause suicide mortality.
Conclusions: A centralised, efficient and
effective area-based model for the management of self poisoning is
described. All toxicology presentations in an area health service
are diverted to one hospital where all DSP presentations are admitted
under the one multidisciplinary team and all receive psychiatric
assessment. This model has resulted in a substantial reduction in bed
stay with considerable potential savings to the Hunter Area Health
Service manifested as an increase in available beds for other
purposes (opportunity cost) in the area.
©MJA 1997
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© MJA 1997
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