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The Comprehensive Snakebite Program at the University of Alabama at Birmingham and Children’s of Alabama now has an option for eligible patients to be treated for venomous snakebites in an outpatient setting. This clinic is among the few in Alabama that allows envenomated patients to be treated in an outpatient setting.

Alabama is home to six venomous snakes. However, 90 percent of envenomation in patients is caused by bites from snakes of the Agkistrodon species such as cottonmouths and copperheads. Standard care for envenomated patients includes prompt antivenom administration and hospital admission for continued observation. However, despite this, patients who are envenomated by copperheads or cottonmouths often do not need a second administration of antivenom. Therefore, experts at UAB are trying to streamline the patient’s care and minimize unnecessary hospital admissions.

“The goal of this program is to prevent overcrowding in our emergency departments for patients who may not need to be admitted and have the ability to benefit from close follow-up in an outpatient setting the very next day,” said Lauren Epp, CRNP, a supervisor in the UAB Ambulatory Care Clinic. “Snakebites typically happen in late afternoon or evenings. With this new option, patients can come to the ED to receive the immediate care they need, get discharged and come back first thing the next morning for a continuation of care.”

With the new addition to the program, patients eligible to be discharged after a medical examination can be given a dose of antivenom in the emergency department, discharged and scheduled for a four-hour follow-up appointment the very next day with the UAB Ambulatory Intermediate Care Clinic. At this appointment, the patient’s care team will monitor swelling to ensure that it is going down and determine whether the patient needs more antivenom. After being observed for four hours, if the patient is healing properly, they will be discharged and can receive follow-up care through the program.

“The goal of this new outpatient clinic is to minimize the burden on the patient,” said William Rushton, M.D., co-director of the Snakebite Program at UAB and Children’s of Alabama. “After a snakebite, the patient can come to our emergency department for a dose of antivenom and then go home to get what they need. Many times, patients rush to the hospital and do not have time to grab what they need for the night, so this new program can allow them to go home and come back the next day for treatment. The patient can grab a new change of clothes, take a shower, get a good night’s sleep in their bed, among other things, while still receiving the same level of comprehensive snakebite care they would get if they were admitted to the hospital.”

When patients arrive at the AICC the next morning, they will begin their appointment by having their vitals checked. The staff at the clinic will then begin circumferential checks around the snakebites and joints to measure the amount of swelling around the snakebite area. They will measure at different times throughout the four-hour appointment to make sure the swelling is progressing as expected. The patient will undergo observation and evaluation by clinic staff. The clinic can also provide other resources the patient may need, including pain medication, IV fluids or a second dose of antivenom, if needed. This clinic is among the only outpatient clinics in the state that provide antivenom in an outpatient setting.

“The biggest benefit for the patients is that they are receiving patient-centered care that is designed to help them feel as comfortable as possible,” Epp said. “Instead of staying in the hospital overnight, patients who prefer to be discharged can go back to the comfort of their own homes and get the same level of care that they would receive in the ED the next morning in an outpatient setting.”

“The program’s co-directors had a vision for how we can improve snakebite care here at UAB,” Epp said. “Their medical innovation and commitment to quality patient care have allowed us to improve the care for envenomated patients in a way that was not possible before.”