poison center services 2008
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Illinois Poison Center
A Public Health Information and Education Service
Why Poison Center Services?
Overview of the IPC History of Poison Centers in
Illinois Mission
Emergency Call Center Services Public Education Professional Education Public Health – Reporting,
Surveillance Research
Poison Center History 1953
First poison control center in the nation: Rush University
Early 1960’s Over 100 poison information
centers in Illinois American Association of Poison
Control Centers (AAPCC) formed
Poison Center History 1980s
Poison centers around the state gradually closed
1990 Three centers left in Illinois None certified by AAPCC
By 1996 Two centers had closed Rush center announced plans to close
Illinois Poison Center October 1997
50% of funding from State of Illinois 50% of funding raised privately
and/or from hospitals Core functions
Call center for healthcare professionals and general public
Professional education
Illinois Poison Center and MCHC
Program of Metropolitan Chicago Healthcare Council (MCHC)
Poison Center History 1997
Rush poison center transitioned to Metropolitan Chicago Healthcare Council
Organized as a not-for-profit 501(3c) under MCHC/Chicago Hospital Council
Name changed to Illinois Poison Center (IPC)
Illinois Poison Center 1998: Certified by AAPCC in 1998
Only AAPCC-certified regional poison center in Illinois
Operational requirements 24/7/365 call center
Professional education requirements Staff requirements
Certified specialist in poison information (CSPI)
Medical toxicologist Medical director On-call staff support
Education and outreach requirements
MissionThe Illinois Poison Center is dedicated to reducing the incidence and injury of poisoning in our communities through immediate expert telephone recommendations, innovative public and health care professional education and focused research.
Our vision is an Illinois that no longer suffers from the harm of poisoning
Emergency Call Center
Available 24 hours a day, 365 days a year via toll-free number
1.800.222.1222
Call Center Services Over 107,000 calls in 2006 Almost 87,400 exposures Over 15,000 calls from health care
providers (17% of calls); most from hospital based personnel We are consultants to healthcare
professionals on toxicology and poisoning
AAPCC Clinical Staff Requirements
Specialists in Poison Information Nurses, Pharmacist, Physician Assistants and
Physicians Poison Information Providers
IPC prefers Pharm. Tech, Paramedics, BA/BS in a life science and health care experience
Medical Directors Board certified in EM, Pediatrics or Preventative
Medicine Board Certified in Medical Toxicology
Illinois Poison Center
Current Clinical Staffing:
16 Pharmacists and nurses (13 FT/3 PT)
7 Poison information providers (6 FT/1 PT)
3 Medical directors (1 FT/ 2 PT)
Types of Calls The IPC provides treatment advice
and information for overdoses, medication errors, occupational accidents, hazardous material incidents, venomous bites and more
51% of exposures involve children under the age of 6 years of age
Emergency Call Center 36% Increase in Service since 2000
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2000 2002 2004 2006
Total Calls
Emergency Call Center ServicesHCF calls increased 21% since 2003
Year Totals
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4,000
6,000
8,000
10,000
12,000
14,000
16,000
2001 2002 2003 2004 2005 2006
Year Totals
Emergency Call Center Services
IPC Staff that answer HCF calls have all been passed a national exam in toxicology and are considered Certified Specialists in Poison Information
Stability, additional training, monthly educational lectures add to depth of experience of staff
IPC CSPI exam scoresIPC scores average = 91% (101/110)
National average = 75% (82/110)
Value of Call Center Services Health Resources and Services
Administration (HRSA) estimates that for every $1 dollar spent on poison control services $7 dollars in health care costs are saved
IPC budget ~4,000,000 so about $28,000,000 saved
Caveat: based on 1980’s and early 1990’s data.
Value of Call Center Services
90% of calls from general public are managed at home with simple first aid instructions
70% of callers would seek healthcare if poison center services are not available
Estimated ED cost of $1,000 Potential savings: $45,000,000
Value of Call Center Services
When poison center services not available, admissions increase by 16%
10,843 admissions in 2005 per hospital discharge data
Extrapolation of an additional 1700 admissions
Average cost of admission from poisoning is $10,843
Potential savings: over $18,000,000
Value of Call Center Services
Length of Stay (LOS) New Jersey Study (2007) showed:
Admitted patients where poison center was consulted had mean LOS of 3.9 days
Admitted patients where poison center was NOT consulted had mean LOS of 6.9 days
Hospital stay for poisoning $1,500 per day average per IDPH data
Potential savings: $56,000,000
Value of Call Center Services
Poison Centers save society money through:
Preventing unnecessary healthcare visits
Decreasing admissions to hospitals Decreasing the LOS at hospitals
Estimated potential savings for Illinois is ~$119,000,000 ($30 saved for every $1 spent)
Public Education Goal #1 is to provide poison
prevention to families and communities to create healthier and safer communities
Public Education Goal #2 is to raise awareness of the
IPC services so as to maximize the value of the call center services in decreasing medical costs.
Public Education
Service Region Size is a significant barrier State of Illinois 12.7 million people 55,000 square miles
Theory of Change Problem
Low utilization of poison center services Accidental poisoning a threat to community
Historically little poison prevention education led by Illinois Poison Centers
Strategies Media, Regional Education Centers,
Volunteer Educators, Professional/community organizations
Assumptions Little history of poison prevention education
led by poison centers, “space” could be filled with good programs and leadership
Theory of Change Planning Tool
Project A + Project B + Project C = Outcome D
• A+B+C are based on someone else’s research, collective experience, historical principles, preponderance of evidence
• A, B and C are the most compelling strategies to achieve and outcome D (success of the program)
IPC theory of change strategy
A + B + C + E = D
Media Hospital Satellite Network
Volunteer Educators
Individuals,Community and Professional organizations
1) Increased awareness 2)Decreased unintentional poisoning
Newspaper TVRadioWeb
12 hospital educators in various regions in the state
“Online educators”
Faith-basedEthnicProfessionalGovernment
Measure and quantify the processes
It is assumed that processes will make a difference over time
Time may be months, years, generations
The only thing one can control is the process and hope the assumptions are correct
Media Processes – press releases, interviews, “mentions” (print)
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2001 2003 2005
ReleasesInterviewsMentions
Media – web utilization (page views)
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2004 2005 2006
PublicProfessionalEducatorTotal
Media Broad ranging – 100’s of thousands if
not millions of people read an article in print, web or hear about the poison center on radio or TV
Passive Difficult to measure at an individual
basis Constant updating to ‘new threats’
Hospital Satellite System Regional Hospital based education
centers throughout the state Train the trainer approach encouraged Educators are regional experts for their
volunteer educators and “online” educators
Quarterly meetings – teleconference One annual face-to-face all day meeting
Beginning to encourage the interaction with more community groups
Volunteer Educator Approach
Educators Trained
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2002 2003 2004 2005 2006
Online
Satellites/IPC
40%
33%
Outreach Events per yearIPC Outreach Events
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1
2002
2003
2004
2005
2006
20%
34%
70%
26%
Satellite Events
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2001 2002 2003 2004 2005 2006
Satellite and IPCeventsOnline EducatorEventsTotal Events
Satellite People Reached
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150000
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250000
2001 2002 2003 2004 2005 2006
Satellites and IPCOnline EducatorsTotal
Community, professional and government organizations
Children’s librarians School Nurse associations EMS DCFS WIC Casa Central HispanoCare Over 20 additional community
organizations throughout the state
Types of events EMS group that has poison prevention
booth at local fairs, parade, community celebrations.
Pharmacy schools and students School Nurses who provide poison
prevention during NPPW Librarians who have a poison
prevention ‘story time theme’
Community and School Education
So, that is a lot of effort…
Case volume over time
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20000
40000
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2000 2002 2004 2006
ExposuresTotal Calls
Penetrance changes by geography (more successful in small metro and rural areas)
Poison Data for Illinois
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16000
2001 2002 2003 2004 2005 2006
In/ enroute to HCF
Treated andReleased
% Treated and Released of In/Enroute to HCF
15% decrease in non-emergent poisoning that presents primarily to ED.
41
42
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45
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50
2001 2004
%treatedandreleased
Causality Control group: National data? Change in number of severe
poisonings (acuity)? Population/Demographic change? Change in training of staff?
Still intriguing Data
Latino Outreach Results with Sinai Community Institute
Total calls increased 18%
Calls from hospital decreased 3%
0500
100015002000250030003500400045005000
2002 2004 2006
TotalCalls
CallsfromHCF
Latino Outreach Results with Sinai Community Institute
Treated and Released decreased 17% from 2002/2003 baseline
Total calls increased 18%, T and R decreased 17%
Poison prevention vs. calling IPC?
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2002 2004 2006
Callsfrom HCF
TreatedandReleased
Latino Outreach Results with Sinai Community Institute
23% reduction in pediatric HCF visits
28% reduction in Pediatric T and R
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2002 2004 2006
Peds callsfrom HCF
TreatedandReleased--Pediatric
Latino Outreach Results with Sinai Community Institute
Essentially unchanged from baseline of 2002/2003
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2002 2004 2006
MedicalAdmissionsall ages
Latino Outreach Results with Sinai Community Institute
36% reduction in pediatric admissions from poisoning
State numbers for control unchanged
Decrease in ED visits and Admissions = >$219,000 saved from baseline
05
101520253035404550
2002 2004 2006
Pediatricadmissions
Theory of Change
What works the best? Not sure if media, satellites or
community organizations is most cost effective
Community Organizations may be better partners in hard to reach populations
Easier to raise foundation money if working with community organizations
Professional Education
Expertise of Poison Center Staff in field of Poisoning an Toxicology
Undergraduate and Graduate Education Medical students Pharmacy students Medical and Pharmacy Residents
Continuing Education for practicing professionals Advanced HAZMAT Life Support (AHLS) Bioterrorism Training and Curriculum Development Program
(BTCDP) Individual Lectures for institutions
Undergraduate Education Medical and Pharmacy Students can
come to IPC for 2 weeks to 6 weeks at a time 12 per year at IPC 26 per year with Toxikon (affiliated
educational organization) Individual lectures at Pharmacy and
Medical Schools About 12 per year at 3 different schools of
pharmacy and 3 school of medicine
Post Graduate Education 80 to 100 medical residents,
pharmacy residents and fellows rotate through Toxikon and the IPC every year
Most emergency medicine residencies in Chicago send their residents for education with the IPC and Toxikon
Continuing Education Advanced HAZMAT Life Support (AHLS)
577 providers Trained since 2002 Bioterrorism Training and Curriculum
Development Program (BTCDP) 624 people educated since 2004
Individual Lectures (~ 10 to 30 per year) to institutions that request presentations to staff
Surveillance Software-driven Surveillance of
National Poison Database System (NPDS)
Individual Reporting: High index of suspicion, clinical awareness Driven by experience
Software surveillance
All exposure calls are logged into an electronic program with two functions
One function is the medical record: Recorded history, physical, assessment
and plan The second is database
All products are coded, route of exposure, location of exposure, clinical effects noted
Software Surveillance The coded fields from every poison
center in the U.S, are uploaded every 20 minutes to New Jersey (essentially real-time)
The data is then analyzed with software developed in conjunction with the CDC (BIOSENSE)
Software Surveillance National Surveillance
three standard deviations from moving 14 day average for past three years creates a notification
Total Call Volume (by center) Human Exposure Volume (by center) Clinical Effects
Procedure Alert at national office
National office investigates data If signal is worrisome, local poison center
contacted for ‘follow back”
Individual Reporting Public Health Reporting by individuals
Astute clinician realizes something is out of the ordinary and reports it to other agencies
Recognition can occur in various points of patient care
Examples of Food Borne Illness Reporting
March 2004 Call to Illinois Poison
Center from HCF re: 2 individual with severe muscle breakdown
Recent ingestion of Buffalo Fish
Dx: Haff Disease
Examples of Food Borne Illness Reporting
Fall, 2006 Call from HCF regarding
patient with numbness, tingling and reversal of hot and cold
Patient recalls eating grouper at restaurant that night
Dx: Ciguatera Poisoning
Examples of Food Borne Illness Reporting
May, 2007 Call from HCF re: patient
who had weakness, near paralysis after ingestion of “puffer fish”
Dx: Tetrodotoxin poisoning
FDA recall
Winter 2005 - 2006 Bootmate sealant Exposures reported to PCC led to
respiratory symptoms ranging from cough to pneumonitis to pulmonary edema
Initially noted by Detroit Poison Center Investigation showed over 179 exposures
with mild to severe clinical effects in midwest and eastern U.S.
Product recalled
Research Current database with 600,000 cases
of poisoning Cases are easily retrieved and
examined
Research Answer questions that have not yet
been answered Change the knowledge base of medicine Change the knowledge base of the public Change the practice of medicine
Research Example
Crack Cocaine Body stuffers
Crack Cocaine Body Stuffers 50 KUB No Foreign Body seen on x-ray In the Chicago area, x-rays are of no
value in the diagnostic work up of a crack cocaine body stuffer Packaging in Chicago may be different
than the packaging in other parts of the country
Research examples Rodenticides – long acting
superwarfarins 750 cases, no bleeding 48 cases with f/u INR, 2 abnormal, both
lab error No cases of true coagulopathy
Heroin Body Stuffers Resurrection Program
65 heroin body stuffers 6 (9%) symptomatic, all within 1 hour of
ingestion 3 (4.6%) needed naloxone
2007 ICEP Resident Research 2007 ICEP Resident Research Award WinnerAward Winner
Retrospective case series All carbamazepine exposures reported
to our regional poison center between January 1, 2001 and December 31, 2005 were investigated.
Inclusion criteria were all acute poisonings with concentrations greater than 12 mcg/mL at any given time.
0
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1 4 7 10 13 16 19 22 25 28 31 34 37 40
Initial (mgc/mL) Highest (mcg/mL)
InitiallyInitially supratherapeuticsupratherapeutic concentration and continued to rise concentration and continued to rise > 12 mcg/mL> 12 mcg/mL
Initially Initially therapeutictherapeutic concentration concentration and continued to rise > 12 mcg/mLand continued to rise > 12 mcg/mL
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Initial (mcg/mL) Hightest (mcg/mL)
Initially Initially subtherapeuticsubtherapeutic concentration and continued to rise concentration and continued to rise > 12 mcg/mL> 12 mcg/mL
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Initial (mcg/mL) Highest (mcg/mL)
Caffeine
Research – why? Change the practice of medicine Improve outcomes Improve public health
Research – Why? RRC requirement Career choices
Academic vs. Community Practice Medical Toxicology Fellowship
Change the useful knowledge base, change the practice of medicine
Cool Trips: North American Congress of Clinical Toxicology
2008 Toronto 2009 San Antonio 2010 Denver
Potential Examples Triage criteria: Do they change
practice? Value? Epidemiology of poisoning
New trends Emerging trends in drug abuse
Coricidin Alternate routes of exposure
ResearchMedical Admissions all Poisoned Patients
010002000300040005000600070008000
2002 2003 2004 2005 2006 2007
Year
num
ber
of a
dmis
sion
s 2002
2003
2004
2005
2006
2007
In summary, the IPC is the place to call
But it is so much more…
It is a comprehensive public health information and education service
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