Journal of Medical Toxicology

, Volume 15, Issue 1, pp 12–21 | Cite as

The Effect of a Medical Toxicology Inpatient Service in an Academic Tertiary Care Referral Center

  • Andrew M. King
  • Shooshan Danagoulian
  • Michael Lynch
  • Nathan Menke
  • Yijia Mu
  • Melissa Saul
  • Michael Abesamis
  • Anthony F. Pizon
Original Study



Morbidity and mortality from poison- and drug-related illness continue to rise in the USA. Medical toxicologists are specifically trained to diagnose and manage these patients. Inpatient medical toxicology services exist but their value-based economic benefits are not well established.


This was a retrospective study where length of stay (LOS) and payments received between a hospital with an inpatient medical toxicology service (TOX) and a similar hospital in close geographic proximity that does not have an inpatient toxicology service (NONTOX) were compared. Controlling for zip code, demographics and distance patients lived from each hospital, we used a fitted multivariate linear regression model to identify factors associated with changes in LOS and payment.


Patients admitted to the TOX center had 0.87 days shorter LOS per encounter and the hospital received an average of $1800 more per patient encounter.


In this study, the presence of an inpatient medical toxicology service was associated with decreased patient LOS and increased reimbursement for admitted patients. Differences may be attributable to improved direct patient care provided by medical toxicologists, but future prospective studies are needed.


Medical toxicology service Economics Quality of health care 


Sources of Funding

This study received the 2013 Medical Toxicology Foundation (MTF) Medical Toxicology Practice Award.

Compliance with Ethical Standards

Conflicts of Interest



  1. 1.
    Rudd RA, et al. Increases in drug and opioid overdose deaths--United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82.CrossRefGoogle Scholar
  2. 2.
  3. 3.
    King WD, Palmisano PA. Poison control centers: can their value be measured? South Med J. 1991;84(6):722–6.CrossRefGoogle Scholar
  4. 4.
    Kearney TE, et al. Health care cost effects of public use of a regional poison control center. West J Med. 1995;162(6):499–504.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Harrison DL, et al. Cost-effectiveness of regional poison control centers. Arch Intern Med. 1996;156(22):2601–8.CrossRefGoogle Scholar
  6. 6.
    Miller TR, Lestina DC. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis. Ann Emerg Med. 1997;29(2):239–45.CrossRefGoogle Scholar
  7. 7.
    Zaloshnja E, et al. The potential impact of poison control centers on rural hospitalization rates for poisoning. Pediatrics. 2006;118(5):2094–100.CrossRefGoogle Scholar
  8. 8.
    Vassilev ZP, Marcus SM. The impact of a poison control center on the length of hospital stay for patients with poisoning. J Toxicol Environ Health A. 2007;70(2):107–10.CrossRefGoogle Scholar
  9. 9.
    Blizzard JC, et al. Cost-benefit analysis of a regional poison center. Clin Toxicol (Phila). 2008;46(5):450–6.CrossRefGoogle Scholar
  10. 10.
    Bunn TL, et al. The effect of poison control center consultation on accidental poisoning inpatient hospitalizations with preexisting medical conditions. J Toxicol Environ Health A. 2008;71(4):283–8.CrossRefGoogle Scholar
  11. 11.
    LoVecchio F, et al. Poison control centers decrease emergency healthcare utilization costs. J Med Toxicol. 2008;4(4):221–4.CrossRefGoogle Scholar
  12. 12.
    Zaloshnja E, et al. The impact of poison control centers on poisoning-related visits to EDs--United States, 2003. Am J Emerg Med. 2008;26(3):310–5.CrossRefGoogle Scholar
  13. 13.
    Galvao TF, et al. Impact of a poison control center on the length of hospital stay of poisoned patients: retrospective cohort. Sao Paulo Med J. 2011;129(1):23–9.CrossRefGoogle Scholar
  14. 14.
    Offerman SR. The clinical management of acetaminophen poisoning in a community hospital system: factors associated with hospital length of stay. J Med Toxicol. 2011;7(1):4–11.CrossRefGoogle Scholar
  15. 15.
    Austin T, et al. A survey of primary care offices: triage of poisoning calls without a poison control center. Int J Family Med. 2012;2012:417823.CrossRefGoogle Scholar
  16. 16.
    Friedman LS, et al. The association between U.S. Poison Center assistance and length of stay and hospital charges. Clin Toxicol (Phila). 2014;52(3):198–206.CrossRefGoogle Scholar
  17. 17.
    Whyte IM, et al. Health care. A model for the management of self-poisoning. Med J Aust. 1997;167(3):142–6.PubMedGoogle Scholar
  18. 18.
    Lee V, et al. Impact of a toxicology service on a metropolitan teaching hospital. Emerg Med (Fremantle). 2001;13(1):37–42.CrossRefGoogle Scholar
  19. 19.
    Curry SC, et al. Effect of a medical toxicology admitting service on length of stay, cost, and mortality among inpatients discharged with poisoning-related diagnoses. J Med Toxicol. 2015;11(1):65–72.CrossRefGoogle Scholar
  20. 20.
    Lindenauer PK, et al. Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med. 2007;357:2589–600.CrossRefGoogle Scholar
  21. 21.
    Rachoin JS, et al. The impact of hospitalists on length of stay and costs: systematic review and meta-analysis. Am J Manag Care. 2012;18(1):e23–30.PubMedGoogle Scholar

Copyright information

© American College of Medical Toxicology 2018

Authors and Affiliations

  • Andrew M. King
    • 1
  • Shooshan Danagoulian
    • 2
  • Michael Lynch
    • 3
    • 4
  • Nathan Menke
    • 5
  • Yijia Mu
    • 3
  • Melissa Saul
    • 3
  • Michael Abesamis
    • 3
  • Anthony F. Pizon
    • 3
    • 4
  1. 1.Wayne State University School of MedicineDetroitUSA
  2. 2.Department of EconomicsWayne State UniversityDetroitUSA
  3. 3.University of Pittsburgh School of MedicinePittsburghUSA
  4. 4.University of Pittsburgh Medical Center (UPMC)PittsburghUSA
  5. 5.Ohio Valley Medical CenterWheelingUSA

Personalised recommendations