A Survey of Primary Care Offices: Triage of Poisoning Calls without a Poison Control Center

Poison control centers hold great potential for saving health care resources particularly by preventing unnecessary medical utilization. We developed a four-question survey with three poisoning-related scenarios, based on common calls to our poison center, and one question regarding after-hours calls. We identified primary care provider offices in our poison center's region from an internet search. We contacted these offices via telephone and asked to speak to an office manager or someone responsible for triaging patient phone queries. Using a scripted form, trained investigators questioned 100 consecutive primary care provider offices on how they would handle these poisoning-related calls if there was no poison center to refer their patients to. Results of our survey suggest that 82.5% of poisoning-related calls to primary care offices would be referred to 911 or an emergency department if there was no poison center. These results further support the role that poison centers play in patient care and health care utilization. 1. Background In 2009 US poison control centers (PCCs) handled over 4.2 million calls related to poisonings, drug information, and environmental exposures (e.g., envenomations), including almost 2.5 million human exposures [1]. Over 90% of these exposures occurred at the caller’s residence and 72.5% were managed on site, thereby not requiring an evaluation at a health care facility. These numbers of calls and percentage of on-site management have been consistent for several years [2]. Past work has shown that PCCs can save health care resources [3–11] including the prevention of unnecessary emergency department (ED) visits, and decrease lengths of stay for poisoned patients [4, 12–14]. One study, involving 2007 data from our single PCC, showed a median savings of $33 million in unnecessary health care charges by managing patients at home [11]. A report from the United States Institute of Medicine estimates that the combined activities of all US PCCs save more than $900 million annually [15, 16]. Other reviews have identified the importance of maintaining government’s financial support of PCCs, [15, 17] including one cost analysis that offered an appropriate summary by concluding that “poison control centers offer a large return on investment” [18]. Despite these data PCCs continue to be challenged with budget cuts [17, 19, 20]. Our PCC routinely conducts quality assurance surveys to identify our need and role within our community. We interview callers and health care providers on several issues including their satisfaction with our