National Poisons Information Service

A service commissioned by Public Health England

 

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Members of the public

seeking specific

information on poisons

should contact:

 

In England and Wales:

NHS 111 - dial 111

 

In Scotland:

NHS 24 - dial 111

 

In N Ireland:

Contact your local GP or

pharmacist during

normal hours; click here

(www.gpoutofhours

.hscni.net/) for GP

services Out-of-Hours.

 

In Republic of Ireland:

01 809 2166

 

Healthcare

professionals seeking

poisons information

should consult:

www.toxbase.org

What impact we have

Poisoning is a major public health issue in the UK. Cases of poisoning account for around 170,000 NHS hospital admissions a year. One of the more common reasons for presentation at a hospital emergency department and for hospital admission, poisoning adds significantly to the workload of UK primary and secondary care services and NHS patient helplines. Poisoning accounts for just under 1% of the total number of NHS hospital admission in the UK each year and a significant workload for hospital emergency departments and minor injuries units.

Commissioning the NPIS uses significant resource and so it is important to assess whether these costs can be justified through benefits provided by the service, such as avoidance of unnecessary hospital referrals and admissions, reduced lengths of stay, and improvements in the quality of treatment for those patients admitted.

 

During 2016/17, a service evaluation was performed to establish the numbers of enquiries from primary care where admission had been avoided through contact with the NPIS. The aim of this study was to evaluate the financial savings associated with avoided unnecessary hospital referrals.

 

Two surveys were performed to collect information from healthcare professionals using the NPIS by contacting the national telephone enquiry line or by accessing TOXBASE. For each platform, enquirers were asked to record their preferred referral pathway (emergency department, GP, pharmacy or home care) before accessing NPIS information and again after this information was provided. Results of this evaluation have recently been published in abstract form.1

 

Provision of telephone advice for more than 2,000 referrals from primary care resulted in an 18% reduction in referrals to emergency departments. There were also significant reductions in referrals to GPs (-15%) and pharmacies (-3%). Extrapolating across a full year, this equated to almost 6,000 avoided ED visits and a financial saving of approximately £1 million on the basis of minimum NHS reference costs alone. For the TOXBASE survey, data collected from 851 respondents suggested that accessing this information source reduced emergency department referrals by 8%, although reductions in GP and pharmacy referrals were not statistically significant. Extrapolated across a whole year, these data suggest that by primary care users accessing TOXBASE, approximately 25,000 emergency department referrals can be avoided annually, with a saving in terms of basic NHS reference costs of approximately £3.9 million.

 

Although these results demonstrate impressive cost savings with primary care users, they need to be interpreted with caution. Not all enquirers completed the survey and the response rate for the TOXBASE survey in particular, although typical for internet surveys of this type, was low (2.7%) and this could introduce some bias. Nevertheless, these results demonstrate the value of the NPIS in reducing the burden on hard pressed emergency departments, GPs and pharmacies by avoiding unnecessary referrals. The overall financial savings accruing from these primary care enquiries alone exceed the overall NPIS budget and do not take into account other cost savings from avoided transport and ambulance costs, better outcomes from improvements in quality of care, shorter hospital inpatient stays, avoidance of referral to other health services and avoidance of productivity loss related to unnecessary health care for patients and carers.

 


References

  1. Elamin MEMO, James DA, Holmes P, Jackson G, Thompson JP, Sandilands EA, et al. Reductions in emergency department referrals from primary care after use of the UK National Poisons Information Service. Clin Toxicol 2017; 55: 481-2.

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