Traditionally, when a patient arrives at the BWH Emergency Department (ED) with a possible poisoning or overdose, the care team calls the Regional Center for Poison Control and Prevention based at Boston Children’s Hospital. A clinical toxicologist – a health care professional with specialized knowledge of the adverse effects of drugs and other chemicals – provides guidelines and advice to the care team on how to best treat the patient.
This year, the Brigham will bring its own medical toxicologists directly to the bedside to share their expertise and care for patients facing adverse effects from medications, drug overdoses and substance abuse issues, thanks to a new division within the Department of Emergency Medicine: the Division of Medical Toxicology.
“Toxicology has been a well-known subspecialty for 20 years or more,” said Michael VanRooyen, MD, MPH, Emergency Medicine chair. “We’re taking a new twist on it through the addition of biotechnology and oncology toxicity research. The division will provide an innovative and unique way of looking at emergency toxicology.”
In addition to providing direct clinical care in the ED and inpatient units, the team will also educate clinical teams and trainees, provide staffing for the Regional Center for Poison Control and Prevention at Boston Children’s Hospital and pursue a variety of toxicology research, including biotechnology research that can share insights on medication compliance.
BWH emergency medicine physician, educator and medical toxicologist Susan Farrell, MD, EdM, is part of the new division, as well as medical toxicologists Edward W. Boyer, MD, PhD, and Peter Chai, MD, MMS, who both recently joined BWH from UMass Medical School in Worcester. Their expertise includes adverse drug events, toxicity, drug interaction and poisoning, and drug overdose. Medical toxicologist Timothy Erickson, MD, who joined BWH last September, serves as division chief. His areas of interest include the study of environmental toxins, venoms and the development of poison control centers in low-resource settings globally.
Once the new clinical service is up and running, medical toxicologists will follow and discuss the management of patients, says Chai. Not only will the bedside service provide personalized care for patients who are poisoned, but it will also help to reduce length of stay and decrease costs. Two examples of how medical toxicologists can achieve this: identifying which patients need to be observed, rather than admitted, and recognizing a poisoning early enough to provide an effective antidote.
Medical toxicology also encompasses opioid abuse, and clinicians have an important role to play in combating the opioid epidemic, says Boyer. “In general, we have to be much more cognizant of how we prescribe medications,” he said. “Research shows that writing somebody an extra handful of medications can have downstream effects on patients and families for decades. Understanding how patients use medications and the ways in which they take them has become ever more important in last few years.”
As director of Academic Development for Emergency Medicine, Boyer is also charged with growing the academic pipeline of new research in the department, toxicology-related and otherwise.
The expansion of Emergency Medicine into toxicology also includes plans to support cancer patients who are dealing with toxicity issues from chemotherapy and other medications. The initiative, which is expected to launch next year, will provide emergency care for cancer patients, as well as care coordination and palliative care for all cancer patients with toxicologic issues.
“We have a personal mission to help cancer patients, and our relationship with DFCI puts BWH at the cutting edge of how to care for them quickly and compassionately,” said Erickson.