Acute drug intoxication management by internal medicine physicians

Abstract

Background：Internal medicine physicians are not as familiar with managing patients with drug intoxication, and therefore, they may feel apprehensive. This study aimed to investigate the awareness and clinical approaches of internal medicine physicians in charge of the emergency departments toward patients with drug intoxication, and to identify challenges and strategies for improving the quality of care for patients with drug intoxication.

Methods：Patients, aged ≧15 years, who were transported to our emergency department between April 2021 and December 2023 for drug overdose were included in the study. We compared the response rates and treatment between emergency physicians vs. internal medicine physicians during different shifts. Additionally, a web-based questionnaire survey was conducted in April 2024 among 25 internal medicine physicians involved in the management of drug intoxication.

Results：Of the 315 patients with suspected drug overdose during the study period, 76 （24.1％） were transported to our emergency department. Twenty-nine patients（38.2％） were transported when an internal medicine physician was in charge. The response rate for patients with drug overdose was 12％, which was lower than the response rate for other diseases. Patients who were treated by internal medicine physicians were often “regular patients”（51.7％ of the total）. General procedures such as gastric lavage or activated charcoal administration were performed equally by emergency physicians and internal medicine physicians. The questionnaire yielded responses from 9 physicians （36.0％）. The survey revealed that many internal medicine physicians felt apprehensive about managing patients with a drug overdose. Especially, many respondents expressed uncertainty about treatment strategy and discomfort with providing psychiatric management.

Conclusion：For internal medicine physicians working in the emergency department, managing drug intoxication is a particularly challenging area. To address this issue, Team-based support systems are essential to improve care.