Insights into poisoning in Singapore and its impact on healthcare resource: Through the lens of a cluster toxicology consultation service

Background: Poisoning contributes to significant morbidity and mortality worldwide, leading to significant hospital resource needs. Toxicology teams provide expert advice and impact management and length of stay for patients. Purpose: In May 2019, the Singhealth cluster toxicology service was started, providing its consult services to all hospitals in the cluster. An audit review of the patients referred to the service over a 2-year period is presented. (May 2019-April 2021). Research Design : A retrospective audit review of consultation records was performed. Study Sample: All patients referred to the Singhealth Cluster Toxicology Service. Data collection and analysis: Patient demographics, exposure patterns, clinical presentation, interventions received, and outcome were examined and presented. Information about resource use (length of stay, critical care utilisation), together with critical poisoning cases, cases placed on extracorporeal membrane oxygenation and fatalities are reviewed and presented briefly. Results: 911 records were analysed. Most were referred from the ED (87.2%), were male (50.7%), and were in the 20-29 age group (29.9%). Most were self-referred (84.3%) with oral ingestion (81.7%) being most common and majority attending for intentional (69.9%) and deliberate self-harm. The most common poison class was analgesics (20.4%), followed by sedatives and antidepressants. There were 509 hospital admissions, with 153 patients requiring HD/ICU admission. The median length of stay was 3 to 5 days respectively. A total of 9 deaths occurred, 3 of which were undoubtedly caused by poisoning. Conclusion: The Singhealth Toxicology Service provides valuable insight in the management of poisoned patients and plays a pivotal role in harm prevention and informing resource allocation.