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In order to justify dedicated staff for night calls, improve the quality of our handling of these calls, and qualify for certification by the AAPCC, we sought an alternative to hiring dedicated night staff. We offered our certified staff members the opportunity to fulfill part of their regular duties answering night calls from home. We set them up with a computer system, dedicated telephone line, texts and consultant information. They were able to access the Poison Center hotline computer via a remote access program. A significant increase took place in the number of documented calls to the Poison Center during the midnight to 8:00 am shift. Quality of documentation also improved significantly and level of service has been complemented by callers. The remote access method is a viable way for a small Poison Center to cover the night shift with certified, reliable, capable staff. This method of call answering has solved our major problem of hiring night staff who would satisfy requirements and provide excellent service.

The Poisons Information Centre (PIC) provides viral and timely information to prevent and manage poisoning episodes. Comprehensive information on household, agricultural and industrial chemicals, natural toxins, pharmaceuticals, local antidote stocks and local poisons experts is retrieved from the Centre's computerised information system and printed literature. Public subscribers can obtain poisons information through Teleview.

The purpose of this work was to formulate guidelines to help health professionals in establishing or strengthening the capabilities of drug and toxicology information centers and related facilities in developing countries. These guidelines are based on the experience of an established drug and toxicology information service in Zimbabwe which has been operating for more than ten years and on information obtained from other centers in developed countries. The guidelines provide advice rather than a unique model and should therefore be adapted rather than adopted. We conclude that national drug policies should include provision for establishing drug information centers. The World Health Organization and similar organizations should assist in establishing these centers. We believe that a drug and toxicology information center is more beneficial to the community when it is part of the teaching curriculum and continuing education for health professionals. Therefore, the center should be located in a medical teaching institution.

Plant identification in response to poison control inquiries poses problems for medical staff and botanists alike. Lack of a specimen for verification combined with a limited description by an untrained lay person hinders confident identification of the plant. In view of these problems a computer identification system has been developed for use in answering poison control calls. A database has been compiled for 103 common houseplants described in lay terms, with respect to 56 features each possessing a number of possible states. The database is used with the MS-DOS polyclave program ONLIN6. Identifications are made by entering data for available features, so as to eliminate taxa until a single taxon remains. This system has been used in 112 mock calls in which the resulting identification could be checked. These trials resulted in correct identifications 65% of the time. Errors were attributed primarily to problems related to translation of character states into lay terminology. Revision of the database is planned that will eliminate these problems. Use of the system by hospital personnel is recommended only after graphics screens have been added to the database, and where staff have been specially trained in botanical terminology and in use of the ONLIN6 program.

In the recent literature, many studies have addressed the evaluation of the user interface in interactive systems. However, there are few theoretically based methodologies for this purpose. This study is an attempt to develop a methodology for examining the complex division of information processing labor between user and computer. A special concern was the computer-naive user searching for information using a self-teaching system. Our test bed was an emergency poison information center whose functioning depended on fast, accurate processing of patient and antidote data by a nurse. We augmented the nurses' traditional information support--a manual card file and reference books--with an interactive software system which summarized and suggested inferences from data on past successful treatment of patients. Analysis of recordings of user comments and user-system interactions showed that: (1) the support system should be more robust and have more "reasoning" power; and (2) the users' expressed information needs changed after the new support was introduced. From the results, we abstracted elements of an effective naive user-support system division of labor: (1) the support system should "actively" help the user's error recovery; (2) the system should have a sufficient knowledge base to allow "intelligent" conversation about the problem domain; and (3) the support system should allow the user to reconceptualize his information problem as his environment changes. Our method of recording user-system interactions and verbal protocols was time consuming, but did yield significant insight into the user-system division of labor. Also, considering the poison center as a living system, analysis of processing by the nurse and the traditional, the new, or an envisioned information support system showed that a highly dispersed associator and effective internal transducer promoted the functioning of the entire group.

A pooling of public and private resources has created a regional poison control system which provides information and education to the medical and lay communities of metropolitan New York City. An overview of the poisoning problem on a national scale is followed by a description of the operations by the Center, and a special volunteer effort.

A retrospective study of 2,526 calls made to a regional poison center demonstrated the value of telephone follow-up of poison exposures. Further treatment recommendations were required in 21.2% of follow-up calls, more than 25% of which were made to physicians. Poison prevention education and data collection were accomplished in more than 95% of cases. Twenty-four telephone follow-up calls corrected major treatment errors, corresponding to a dramatic change in patient management more than twice each week. This study delineates the functions and value of the follow-up call in the treatment and prevention of poisonings and in toxicologic research. Because the effective use of this procedure is limited to comprehensive poison centers with vast resources and full-time staff, this study further supports regionalization to promote maximal utilization of this and other elements of poison control.

The Rocky Mountain Poison Center is a model system for regionalization. Minimal cost is achieved by concentrating expensive equipment and information materials in the main center. Access to information is rapid because each subregional center has a POISINDEX and thus the capacity to provide standardized initial therapy as soon as contact is made. Full integration of professional activities from training to education is accomplished within the framework of Emergency Medical Services. Public education is uniform throughout the region so that medical interaction is consistent and the public receives maximum reinforcement. Funding is found through many sources and includes a cost-sharing program in which 18 Colorado hospitals participate. Institutions with similar regionalized programs, integrated with Emergency Medical Services and drug consultation, will provide cost effective programs well-tailored to the unique characteristics of each region.

The Massachusetts Poison Information Center has proved to be a good location for the teaching of clinical toxicology to physicians, pharmacists, and nurses at all periods of their training and professional development. With a continuous source of clinical problems, the availability of sophisticated information resources, and a wide array of clinical consultants, a center can become the setting for formal courses in toxicology, for fellowship training, and for continuing education. Review of clinical cases, discussion of management issues, literature reviews, bedside toxicology teaching, and formal weekly toxicology seminars are used to accomplish the educational goals of the program.

State and federal law provided the impetus to develop a coordinated statewide poison system in Massachusetts. To achieve this objective the Commissioner of the Department of Public Health established a Statewide Poison Committee, composed of poison control representatives, physicians, nurses, and pharmacists. After a year of regular meetings, a structure for a statewide poison system was developed, meetings, a structure for a statewide poison system was developed, and as January 1978 this System has been operational in Massachusetts. The structure is based on the Department of Public Health contracting with an incorporated institution to implement the Statewide System, which consists of one information center available to the public and professionals as well as a network of all 112 acute care hospitals in the State as "member institutions." Educational institutions" are further designated with a responsibility of professional and public education in various geographic areas throughout the State. The System is responsible for providing comprehensive poison information, treatment, public education, professional education, data collection, and research. A senior Advisory Board representing institutions with major contributions to the System as well as a Coordinating Committee representing diverse geographic and professional interests serve in an advisory capacity to the System. Funding is broad-based and includes federal, state, and private institutional support.

MPCS developed a model for poison control which includes a member hospital network besides the regional information center. The network provides a mechanism for establishing information center credibility among hospitals and securing additional funds. Supported by the state hospital association, the membership network has contributed 22% of revenues for system's operations from annual dues of +305 to +882/hospital. Dues entitle hospitals to free managements and publications and public education materials at reduced price. The network has maintained on average 100 member hospitals per year with a 90% continuity rate. Members include 88 (79%) of 112 acute care regional hospitals (88% of teaching, 91% of large and 67% of small community hospitals). Network advantages to hospitals are the incentive to consult with MPCS without losing patients and staff education through consultation and rounds. Advantages to MPCS are an increase in staff and toxicology fellow expertise through consultation, teaching, and protocol formulation, research sites, and professional and public calls.

A prospective study was conducted to compare access-to-information times using Poisindex on microfiche versus the computerized version. A time study was conducted in 2 separate phases in the Pittsburgh Poison Center by professional time management engineers who observed certified poison information specialists. The microfiche phase was completed as a portion of a more extensive time management study, and the phase to evaluate the computerized version was completed 9 months after the system had been implemented to insure standardized competency. Access time was defined as the length of time required for the initial information to appear on either the microfiche viewer or the CRT. The average access time for microfiche use was 37.2 sec compared to 18.0 sec for the computerized version, an improvement of 106%. Based upon an annual volume of approximately 40,000 cases, the 19.2 sec savings in access time results in a time savings of 213 hours per year. To generate time savings equivalent to a 0.5 FTE position, a reduction of 1.47 min/call in the overall processing time is necessary. However, the time savings may improve patient care through easier and more extensive access to information and may allow more time for thorough documentation.

The delivery of consultation for treatment of acute intoxication encounters several obstacles. The physician must recognize the case with which he needs assistance; he must be aware that assistance is available; the help must be technically correct; the delivery system must maintain responsible professional continuity while providing consultation at the time and place where it is required. The consultation must be appropriate to the clinical problem at hand in that immediate life-threatening aspects are covered quickly while continuing care and principles are deferred. Availability of specialized equipment and drugs must be assured by some method of precrisis communication. A system for delivery of telephone consultation for the treatment of acute intoxication is described. The system is based on a collection of prepared tapes, providing consultation of 3 to 6 min duration, oriented toward specific topics such as etiologic substances, common clinical syndromes, and commonly encountered complications. The advantages and disadvantages of the program are discussed.

In 1984 the Poison Center installed a Dacon ACS-46 Automatic Call Sequencer. This device is connected to all incoming poison information lines (with the exception of a specially designated 911 line) and acts as an interface between callers and Poison Information Specialists during periods of heavy call loads. While the use of a call sequencer could never be termed ideal, such use offers a number of specific benefits in situations that are frequently encountered in Poison Center work. These benefits include: significant reduction in staff stress, caller assurance that a correct number has been reached, efficient triage of incoming calls, and accumulation of accurate incoming call data. Data input parameters of this system include: total calls offered, dropped calls, calls over alarm time, average time for completed calls, average time for dropped calls, and completed and dropped hold time data bins.

The history, effectiveness, and services of regional poison control centers are reviewed. In addition, the American Association of Poison Control Centers criteria for designation as a regional poison control center are presented.