A MODEL FOR THE MANAGEMENT OF SELF-POISONING

Objective: To describe the development and activity of a multidiscipli nary service to manage self-poisoning. Design: Descriptive, comparativ e study with prospective data collection. Setting: Regional toxicology treatment centre in the Hunter area of New South Wales (NSW) with pri mary and secondary referral service to 385 000 people and tertiary ref erral service to a further 100 000. Patients: All patients (1987-1995) with poisoning or envenomation presenting to the Hunter Area Toxicolo gy Service (HATS). Main outcome measures: Average length of stay for H ATS compared with national and NSW hospitals; mortality data for HATS compared with NSW. Results: Average length of stay for HATS was 0.53-1 .22 days shorter than for all Australian hospitals, potentially saving 518 bed-days, valued at $468 000 per year. Average length of stay was 0.94-3.39 days shorter than for all NSW hospitals, saving 1470 bed-da ys at $1.4 million per year. Inpatient mortality (0.2%; 95% confidence interval, 0.0-1.1) was not significantly different from NSW (0.5%; 95 % CI, 0.2-0.8). Standardised mortality ratios showed no greater all-ca use suicide mortality. Conclusions: In our centralised model for manag ing self-poisoning, all toxicology patients in an area health service are diverted to one hospital, where all patients with deliberate self- poisoning are admitted under the one multidisciplinary team, and all r eceive psychiatric assessment. This model has substantially reduced be d stay, with considerable savings to the Hunter Area Health Service ma nifested as an increase in beds available for other purposes.