Module 7 – Disposition and Follow-Up

Learning Objectives

1. Determine the most appropriate discharge destination for poisoned patients
2. Recognize clinical factors necessitating inpatient admission or ICU monitoring
3. Establish safe criteria for discharging patients home after ED management
4. Arrange needed outpatient follow-up care and monitoring after discharge

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Key Disposition Considerations

Patients who are clinically stable after a period of ED observation may be appropriate for discharge home. However, the following factors may indicate the need for admission:

• Ongoing depressed mental status or respiratory depression requiring monitoring
• Persistent cardiac arrhythmias or hypotension necessitating intravenous medications
• High suicide risk requiring inpatient psychiatric care once medically stable
• Inadequate home supervision or psychosocial support for safe outpatient care
• ICU admission is warranted for patients needing mechanical ventilation, vasopressor support, or continuous antidote infusions.

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Criteria for Safe Discharge Home

– Patient is alert and oriented with normal vital signs and physical exam

– No evidence of continuing toxicity or withdrawal syndromes

– Documented low short-term suicide risk based on psychiatric assessment

– Adequate supervision and support available at home residence

– Patient demonstrates capacity to comply with discharge instructions

– Follow-up outpatient laboratory testing and appointments scheduled

– Prescriptions given for medications to treat withdrawal or pain syndromes

– Education on warning signs and symptoms requiring immediate ED re-presentation

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Outpatient Follow-Up Recommendations

– Check acetaminophen, salicylate, or lithium level the next morning if initially elevated

– Follow trend in liver enzymes, creatinine, coagulation profile for major ingestions

– Ensure mental health resources in place – counselor, psychiatrist, crisis line

– Schedule early follow-up visit with social work and addiction medicine/psychiatry

– Educate to avoid driving or heavy machinery until clinical status cleared

– Provide poison control contact information for questions after discharge

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In summary, thoughtful patient selection is key for safe discharge. Admission is preferred for any uncertainty regarding stability or outpatient support. Close outpatient follow-up ensures detection of delayed toxicity.