Toxicology service a valuable resource in managing poisoning cases in SG: study

Poisoned individuals form a substantial part of the patient population in Singapore, with prognoses that require early recognition and appropriate measures, according to a study.

“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,” the researchers said.

“Periodical audit reviews of data collected can inform future planning efforts for resource allocation and efficient utilization of hospital beds,’ they added.

The Singhealth cluster toxicology service began in May 2019 to provide consult services to all hospitals in the cluster. A group of researchers then performed a retrospective audit review of consultation records of all patients referred to the service.

The research team examined patient demographics, exposure patterns, clinical presentation, interventions received, and outcomes. They also reviewed information on resource use (ie, length of stay, critical care utilization), along with critical poisoning cases, cases placed on extracorporeal membrane oxygenation, and facilities.

A total of 911 records were analysed. Most poisoned patients were referred from the emergency department (87.2 percent), male (50.7 percent), and aged 20 to 29 years (29.9 percent). [Proc Singap Healthc 2026;doi:10.1177/20101058261424020]

Many of the patients were self-referred (84.3 percent), with oral ingestion (81.7 percent) being the most frequent. Most poisoning incidents were intentional (69.9 percent), due to deliberate self-harm and drug abuse, shedding a light on a problem for which prevention can help address. Analgesics (20.4 percent) were the most common poison class, followed by sedatives and antidepressants.

Furthermore, the total number of hospital admissions was 509, with 153 patients admitted to the high-dependency or intensive care units (HD/ICU). The median length of stay was 3 to 5 days, respectively. Nine deaths occurred, of which three were caused by poisoning.

“Poisoning contributes to significant morbidity and mortality worldwide, leading to significant hospital resource needs,” the researchers said. “Toxicology teams provide expert advice and impact management and length of stay for patients.”

Toxicology service

Most calls (62.3 percent) for poisoning cases were made after office hours, when senior staffing in many hospitals was already reduced. 

“This illustrates how a 24-h toxicology phone consult service is a valuable resource for the management of poisoned patients, who require prompt assessment and prognostication, experienced management from senior healthcare staff, expedient treatment including antidote use and employment of hospital resources to provide supportive care and extracorporeal toxin removal,” the researchers said. 

Earlier studies have shown the benefits of toxicology service for inpatient management. [Emerg Med Australasia 2017;29:310-314; J Toxicol Environ Health A 2007;70:107-110; Clin Toxicol 2014;52:198-206; Hong Kong J Emerg Med 2007;14:134-143; Br J Clinical Pharmacol 2019;85:11-19]

“The toxicology service can also serve a surveillance function for occupational health issues, medication error, drug abuse patterns, and poisonings from malicious/deliberate intent with risk to public health,” the researchers said. “The service could work closely with stakeholders to introduce measures to improve medication safety and better protect workers and the public.”

Singhealth is one of the three healthcare clusters in Singapore, with a total attendance of 368,983 patients in 2019. [https://www.singhealth.com.sg/about-singhealth/newsroom/Documents/%5bWeb_Version%5d_singhealth_DukeNUS_Annual_Report_20-21.pdf]