Online Program

Implementation of Comprehensive Inpatient Tobacco Cessation Services Following Joint Commission Recommendations: Lessons Learned and Recommendations

Monday, November 2, 2015

Kathleen Cartmell, PhD, MPH, College of Nursing, Medical University of South Carolina, Charleston, SC
Georges Nahhas, PhD, MPH, Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
Graham Warren, MD, PhD, Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
Matthew Carpenter, Medical University of South Carolina, Charleston
Dianne Wilson, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
Danny Woodard, Oncology and Med-Surg Services Administration, Medical University of South Carolina, Charleston, SC
Peter Fallis, TelASK Technologies, Inc., Ottawa, ON, Canada
Vince Talbot, TelASK Technologies, Inc., Ottawa, ON, Canada
Katherine Hoover, PharmD, BCPS, Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC
Kenneth Michael Cummings, PhD, Medical University of South Carolina, Charleston, SC
Issue: Tobacco use causes adverse health outcomes in hospitalized patients which include poor wound healing, reduced pulmonary function and increased complications. Thus, the Joint Commission (JC) recommends that hospitals screen all patients for tobacco use and offer inpatient cessation support and follow up within 30 days after hospitalization. Currently, few hospitals provide these services.  

Description: In 2014, the Medical University of South Carolina implemented a tobacco cessation service modelled after the JC-recommended standard. Operationally, the program uses electronic health records to automatically identify all tobacco users at admission, refer patients to an inpatient tobacco counselor, and deliver post-discharge calls to assess smoking status and offer referral to tobacco cessation support services.   

Lessons Learned: In 2014, the program screened 18,091 patients for tobacco use, identified 4,735 current tobacco users (23%), and provided inpatient and/or phone support to 3,262 patients (69% of tobacco users). One-month follow-up calls were completed with 42% of patients. A number of valuable lessons learned were identified. First, involvement of those in charge of hospital electronic health records was essential. Second, it is important to develop quality indicators and systems for continuous quality improvement. Third, with a single bedside counselor we were only able to reach 35% of tobacco users during their hospital stay. Finally, phone follow-up after discharge is challenging with less than a 50% response rate. Other methods are currently being explored to increase response to follow up contact (i.e. e-mail, texting). 

Recommendations: Delivery of JC-recommended tobacco cessation services was feasible in a large teaching hospital. Bedside counseling is important, as smoking relapse was 50% lower in patients who saw the counselor than in those who did not. Studies are underway to investigate the impact of the service on clinical outcomes such as hospital readmission rates.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe the key components of a comprehensive inpatient tobacco cessation intervention as defined by Joint Commission recommendations. Discuss at least three factors to consider when designing and implementing a comprehensive inpatient tobacco cessation program.

Keyword(s): Tobacco Control, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a cancer prevention and control researcher for approximately ten years. In addiiton, I have substantial experience and training in the fields of epidemiology and health services research. Among my scientific interests has been the development of strategies to improve access to tobacco cessation services for at-risk populations, such as those who are hospitalized and those who have limited access to healthcare services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.