Association between bedside medical toxicology consultation and hospital triage and resource utilization for poisoned...

Bedside medical toxicology consultation represents a specialized model of care distinct from remote poison center guidance. Despite the importance of toxicologic emergencies in emergency medicine, the association between bedside toxicology expertise and patterns of hospital care is understudied. We sought to characterize associations between bedside medical toxicology consultation and patterns of hospital disposition, length of stay, and selected therapies among poisoned patients.

We conducted a propensity score-matched retrospective cohort study using inverse probability treatment weighting to compare outcomes between patients managed with a medical toxicology consultation and those who were not, among all patients treated for a poisoning at a tertiary care academic medical center between July 1, 2017, and April 30, 2023. The exposure was receipt of a medical toxicology consultation within 48 h of presentation. Outcomes included ED management without medical admission, admission to higher levels of care (floor, intensive care unit [ICU]), length of stay, and use of targeted interventions and supportive therapies. We estimated adjusted odds ratios (aOR) and adjusted mean differences (aMD) with 95% confidence intervals (CI) using weighted multivariate logistic and linear regression models.

Of 13,241 encounters for poisoning, 1077 (8.1%) received a MedTox consultation. A greater proportion of MedTox encounters were managed entirely in the ED without hospital admission compared with non-consult encounters (27.4% vs 9.1%). MedTox consultation was associated with higher odds of ED management without admission (aOR 3.20, 95% CI 2.70, 3.80), lower odds of floor admission (aOR 0.04, 95% CI 0.03, 0.04), and higher odds of ICU admission (aOR 14.00, 95% CI 12.05, 16.27). MedTox consultation was also associated with higher use of true targeted interventions and supportive therapies, including acetylcysteine (aOR 5.90, 95% CI 4.25, 8.10), sodium bicarbonate (aOR 9.39, 95% CI 6.90, 12.71), calcium gluconate (aOR 7.41, 95% CI 5.55, 9.81), and ventilator support (aOR 9.57, 95% CI 6.52, 14.00). MedTox encounters had similar or shorter lengths of stay across levels of care, including shorter ICU stays (aMD -3.65 h, 95% CI -6.34, -0.96).

Bedside medical toxicology consultation was associated with distinct patterns of hospital triage, including higher odds of ED-based medical clearance and ICU admission for higher-acuity cases, greater use of targeted therapies, and similar or shorter lengths of stay across levels of care. These findings suggest that integrating medical toxicology services into emergency and inpatient care may enhance the precision and timeliness of management for poisoned patients while supporting efficient use of hospital resources.