Clinical Toxicology | 2021
Modifying triage protocols for poisoned patients during the COVID-19 pandemic to contribute to preservation of healthcare capacity: early experience of the New Zealand National Poisons Centre
Abstract
In March 2020, nationwide restrictions on population movements were introduced in New Zealand due to the COVID-19 pandemic; the NZ Government adopted a four-level alert system to contain the spread of the virus in the country [1]. For the duration of Alert Level 4 (Figure 1), the New Zealand National Poisons Centre (NZNPC) adopted modified triage protocols for medical referrals to contribute towards preservation of healthcare system capacity. Historically, NZNPC practice has been to provide risk assessment and management advice at the time of a call without routinely performing follow up calls as part of its assessment process or to determine patient outcomes. With modified triage, selected patients who under normal circumstances would have been referred for medical assessment, were instead managed at home with additional NZNPC support consisting of follow up calls at appropriate timeframes based on anticipated toxicity. This approach was very individualised, but there were exposure categories such as gastrointestinal irritants and selected eye exposures where modified triage was more likely to be considered. To assist future NZNPC actions in the case of a second wave of COVID-19 occurring, and to learn from the NZNPC’s early experience, we performed a retrospective review of NZNPC case data from 1 January to 2 August 2020. The rate of modified triage, medical toxicologist consultations, and medical referrals were determined in relation to New Zealand’s COVID-19 restriction timings. Total weekly exposure call numbers for 2020 and 2019 were also described for context. There were 13,251 human exposure calls between 1 January and 2 August 2020 (12,795 in 2019 for the same period). During the restrictions period, the percentage of patients advised to seek medical assessment reduced, while the percentage of medical toxicologist consults increased (Figure 1). Modified triage was documented in 211 contacts. This represented 9.4% of the total 2,243 contacts during the modified triage period. Call durations were similar, but an increase was observed in call numbers compared to the