Evaluation of a new in-patient protocol for treatment of tobacco use at a large academic medical center

Background: The Joint Commission recently developed core measures for screening and treatment of tobacco use since hospitalization provides a great opportunity for helping patients to quit smoking. This study was undertaken to evaluate a new program that systematically identifies and offers treatment to all in-patient tobacco users at University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) in Seattle. The program was implemented in conjunction with a new tobacco-free hospital campus policy and included modifications of electronic medical record-based processes for intake screening, physician orders, nursing protocols, and a pharmacist-delivered brief intervention.

Methods: Hospital records for all patients 18 years and older admitted during the 2011 calendar year were reviewed (n=38,033) to determine rates of current smoking, screening for tobacco use, and referral for treatment with nicotine replacement therapy (NRT) and cessation counseling.

Results: Approximately 10% of all patients admitted to UWMC/HMC screened positive for current smoking (past 30 days). Screening rate for tobacco use across hospital units was high (90%) as was the rate for offering NRT (85%) and counseling (80%). However, less than half of tobacco-using patients (45%) accepted the offer of NRT and only a quarter (25%) accepted cessation counseling.

Conclusion: While rates of screening and offering tobacco treatment (NRT and counseling) are quite high in these hospitals, relatively few patients take advantage of the assistance available for quitting tobacco. Further evaluation is needed to assess factors associated with uptake of treatment to increase the reach and effectiveness of delivering in-patient tobacco cessation interventions.