An intervention based on the Electronic Medical Record to improve smoking cessation guidance in an urban tertiary care center emergency department

Michael P Phelan; Balaji Nithianandam; Nathan Eikoff; Daniel Good; Fredric M Hustey; Stephen Meldon

doi:10.18332/tpc/107116

An intervention based on the Electronic Medical Record to improve smoking cessation guidance in an urban tertiary care center emergency department

Tob Prev Cessat. 2019 May 6:5:16. doi: 10.18332/tpc/107116. eCollection 2019.

Authors

Michael P Phelan¹, Balaji Nithianandam², Nathan Eikoff¹, Daniel Good³, Fredric M Hustey¹, Stephen Meldon¹

Affiliations

¹ Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States.
² Metro Health Medical Center, Cleveland, Ohio, United States.
³ Northeast Ohio Medical University, Rootstown, Ohio, United States.

Abstract

Introduction: Smoking remains a major public health issue and a leading cause of death and disability in the United States. The objective of this study was to determine the effect of a simple intervention on smoking guidance, based on the electronic medical record (EMR), including providing discharge instructions and/or cessation counseling to emergency department (ED) patients who smoke.

Methods: This was an interventional before-and-after study in an ED with 70000 visits per year. A pre-intervention and post-intervention chart review was performed on a random sample of ED visits occurring in 2014 and 2016, identifying smokers and the frequency with which smokers received discharge instructions and/or cessation counseling. In the fall of 2015, our EMR was programmed to deploy smoking cessation discharge instructions automatically.

Results: In all, 28.7% (172/600; 95% CI: 25.2-32.4%) reported current smoking in the pre-intervention ED population and 27.6% (166/600; 95% CI: 24.2-31.4%) reported smoking in the post-intervention population. Smoking cessation guidance was provided to a total of 3.5% of self-reported smokers in the pre-intervention group (6/172; 95% CI: 1.4-7.6%); 1.2% (2/172; 95% CI: 0.3-4.1%) were informed of smoking cessation resources as part of their printed ED discharge instructions and 2.3% (4/172; 95% CI: 0.9-5.8%) received smoking cessation counseling by the ED provider. There was a statistically significant increase in the proportion of patients receiving any smoking cessation guidance after the intervention. All patients (166/166; 95% CI: 97-100% in this period received ED discharge instructions and a list of smoking cessation resources and 3.6% of smokers (6/166; 95% CI: 1.7-7.7%) received smoking cessation counseling by the ED provider.

Conclusions: Automated deployment of smoking cessation discharge instructions in the EMR improves smoking cessation discharge instructions, and also has a positive impact on improving rates of in-person counseling by ED providers.

Keywords: discharge instructions; emergency medicine; guidance; smoking; smoking cessation.