Alternative models for telephone response to pediatric poisonings.
BACKGROUND
Poison Control Centers (PCCs) provide telephone consultations to manage poisonings. They are threatened with funding loss. Policy decision-makers have requested an evaluation of alternate models for telephone management of poisonings.


OBJECTIVE
We examined the feasibility of alternative models for the telephone management of poisonings from the public.


METHODS
Alternative models evaluated included emergency medical dispatchers (EMDs), advice nurses (RNs), and poison information providers (PIPs) to manage real and hypothetical poisonings with protocols or computerized references (Poisindex) with and without PCC backup.


RESULTS
EMDs and RNs with a structured protocol and access to a PCC specialist were able to manage a small subset of poisoning calls. EMDs and RNs managed 6% and 12% of poisoning calls respectively. Non-protocol management of hypothetical cases using Poisindex resulted in mismanagement of cases and longer periods of time to manage cases. PIPs within a PCC were able to manage a substantially greater proportion of calls, but had a significant portion of non-productive time waiting for a PCC call.


CONCLUSIONS
EMDs, RNs, and technician-level PIPs can manage a subset of poisoning cases using structured protocols. Alternative providers were dependent on PCC staff for consultation of the majority of poisoning calls. There are several obstacles to these models and their cost-effectiveness needs to be determined. These studies were the basis of a new staffing model with the integration of PIPs into the call response system in California.
Kearney
T E
TE
Department of Clinical Pharmacy, California Poison Control System, San Francisco, UCSF, CA 94143-1369, USA. pcctk@calpoison.org
Hiatt
P H
PH
Olson
K R
KR
D017598:Efficiency, Organizational; D015277:Hotlines / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D017146:Models, Organizational; D010372:Pediatrics; D011041:Poisoning; D012495:San Francisco