Heather Bennett

High call volume at poison control centers: identification and implications for communication

Context. High volume surges in health care are uncommon and unpredictable events. Their impact on health system performance and capacity is difficult to study. Objectives. To identify time periods that exhibited very busy conditions at a poison control center and to determine whether cases and communication during high volume call periods are different from cases during low volume periods. Methods. Call data from a US poison control center over twelve consecutive months was collected via a call logger and an electronic case database (Toxicall®).Variables evaluated for high call volume conditions were: (1) call duration; (2) number of cases; and (3) number of calls per staff member per 30 minute period. Statistical analyses identified peak periods as busier than 99% of all other 30 minute time periods and low volume periods as slower than 70% of all other 30 minute periods. Case and communication characteristics of high volume and low volume calls were compared using logistic regression. Results. A total of 65,364 incoming calls occurred over 12 months. One hundred high call volume and 4885 low call volume 30 minute periods were identified. High volume periods were more common between 1500 and 2300 hours and during the winter months. Coded verbal communication data were evaluated for 42 high volume and 296 low volume calls. The mean (standard deviation) call length of these calls during high volume and low volume periods was 3 minutes 27 seconds (1 minute 46 seconds) and 3 minutes 57 seconds (2 minutes 11 seconds), respectively. Regression analyses revealed a trend for fewer overall verbal statements and fewer staff questions during peak periods, but no other significant differences for staff-caller communication behaviors were found. Conclusion. Peak activity for poison center call volume can be identified by statistical modeling. Calls during high volume periods were similar to low volume calls. Communication was more concise yet staff was able to maintain a good rapport with callers during busy call periods. This approach allows evaluation of poison exposure call characteristics and communication during high volume periods.

Communication patterns for the most serious poison center calls

Context. The communication demands faced by specialists in poison information (SPI) are unique in the health-care context. Objectives. (1) To describe SPI communication patterns for the highest risk poison exposure calls using cluster analysis, and (2) to describe variation in communication patterns or clusters. Methods. A sample of 1 year of poison exposure calls to a regional poison control center with SPIs’ perceived severity rating of major or moderate perceived was collected. Digital voice recordings were linked with medical records and were coded using the Roter Interaction Analysis System. Descriptive analyses were applied, and cluster-analytic techniques were used to assess variation in call communication and factors associated with that variation. Results. Cases were described, and four communication styles were identified. The informational cluster represents calls with relatively high levels of SPI clinical information and caller questions. The Facilitative cluster represents calls with a pattern of relatively high SPI questions and caller information provision. The Planning cluster represents calls with relatively high levels of SPI relationship talk. The Emotional cluster represents calls with relatively high caller and SPI emotion. Further analyses revealed relationships between call characteristics, SPI identity, and cluster membership. Conclusion. This study provides a beginning step to understanding SPI communication behaviors. Our results suggest that SPIs are able to use a range of communication strategies that often involve not only information but also emotional responsiveness and rapport building. Findings also point to the opportunity for future communication training for SPIs to meet the needs of the heterogeneous caller population.

The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis

Objective: The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. Methods: A multi‐year (2009–2014) analysis of cross‐sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Results: Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on‐site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physicians office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between

Characterizing risk factors for pediatric lamp oil product exposures

16.6 and

Simple Workflow Changes Enable Effective Patient Identity Matching in Poison Control

24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Conclusions: Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers.

Reference Website Use Patterns of Poison Control Center Specialists

Abstract Poisonings from lamp oil ingestion continue to occur worldwide among the pediatric population despite preventive measures such as restricted sale of colored and scented lamp oils. This suggests that optimal prevention practices for unintentional pediatric exposures to lamp oil have yet to be identified and/or properly implemented. Objective. To characterize demographic, health data, and potential risk factors associated with reported exposures to lamp oil by callers to poison centers (PCs) in the US and discuss their public health implications. Study design. This was a two part study in which the first part included characterizing all exposures to a lamp oil product reported to the National Poison Data System (NPDS) with regard to demographics, exposure, health, and outcome data from 1/1/2000 to 12/31/2010. Regional penetrance was calculated using NPDS data by grouping states into four regions and dividing the number of exposure calls by pediatric population per region (from the 2000 US census). Temporal analyses were performed on NPDS data by comparing number of exposures by season and around the July 4th holiday. Poisson regression was used to model the count of exposures for these analyses. In the second part of this project, in order to identify risk factors we conducted a telephone-based survey to the parents of children from five PCs in five different states. The 10 most recent lamp oil product exposure calls for each poison center were systematically selected for inclusion. Calls in which a parent or guardian witnessed a pediatric lamp oil product ingestion were eligible for inclusion. Data on demographics, exposure information, behavioral traits, and health were collected. A descriptive analysis was performed and Fishers exact test was used to evaluate associations between variables. All analyses were conducted using SAS v9.3. Results. Among NPDS data, 2 years was the most common patient age reported and states in the Midwestern region had the highest numbers of exposure calls compared to other regions. Exposure calls differed by season (p < 0.0001) and were higher around the July 4th holiday compared to the rest of the days in July (2.09 vs. 1.89 calls/day, p < 0.002). Most exposures occurred inside a house, were managed on-site and also had a “no effect” medical outcome. Of the 50 PC-administered surveys to parents or guardians, 39 (78%) met inclusion criteria for analysis. The majority of ingestions occurred in children that were 2 years of age, that were not alone, involved tiki torch fuel products located on a table or shelf, and occurred inside the home. The amount of lamp oil ingested did not appear to be associated with either the smell (p = 0.19) or the color of the oil (p = 1.00) in this small sample. Approximately half were asymptomatic (n = 18; 46%), and of those that reported symptoms, cough was the most common (n = 20, 95%) complaint. Conclusions. Lamp oil product exposures are most common among young children (around 2 years of age) while at home, not alone and likely as a result of the product being in a child-accessible location. Increasing parental awareness about potential health risks to children from these products and teaching safe storage and handling practices may help prevent both exposures and associated illness. These activities may be of greater benefit in Midwestern states and during summer months (including the period around the July 4th holiday).

Descriptive Analysis of Communication Patterns Between a Local Poison Control Center and Community Emergency Departments

Background  U.S. poison control centers pose a special case for patient identity matching because they collect only minimal patient identifying information. Methods  In early 2017, the Utah Poison Control Center (Utah PCC) initiated participation in regional health information exchange by sending Health Level Seven Consolidated Clinical Document Architecture (C-CDA) documents to the Utah Health Information Network and Intermountain Healthcare. To increase the documentation of patient identifiers by the Utah PCC, we (1) adapted documentation practices to enable more complete and consistent documentation, and (2) implemented staff training to improve collection of identifiers. Results  Compared with the same time period in 2016, the Utah PCC showed an increase of 27% ( p  < 0.001) in collection of birth date for cases referred to a health care facility, while improvements in the collection of other identifiers ranged from 0 to 8%. Automated patient identity matching was successful for 77% (100 of 130) of the C-CDAs. Conclusion  Historical processes and procedures for matching patient identities require adaptation or added functionality to adequately support the PCC use case.

Specialist discrimination of toxic exposure severity at a poison control center

The purpose of this pilot study was to describe web reference use patterns of poison control center specialists using time tracking software. We analyzed two weeks of web site use data from Utah poison control center (PCC) computers to describe patterns of reference web site use. We observed frequent use of webPOISONCONTROL and Amazon. Specialists visited additional reference web sites that feature tools such as calculators websites provided the function of age calculation was visited sometime. In the future we plan to conduct a qualitative study to interview Specialists in Poison Information to get the rationales of visiting these webpages. This pilot study demonstrates the utility of time tracking software for better understanding reference utilization in the PCC setting.

Patient Identity Matching for Health Information Exchange between Poison Control Centers and Emergency Departments.

Poster Abstract