An intervention based on the Electronic Medical Record to improve smoking cessation guidance in an urban tertiary care center emergency department
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Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States
Metro Health Medical Center, Cleveland, Ohio, United States
Northeast Ohio Medical University, Rootstown, Ohio, United States
Michael P. Phelan   

Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States
Publish date: 2019-05-06
Submission date: 2018-08-23
Final revision date: 2019-04-10
Acceptance date: 2019-04-11
Tob. Prev. Cessation 2019;5(May):16
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.

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.

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 preintervention 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.

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.

The manuscript was copyedited by L.J. Kesselring.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Not commissioned; externally peer reviewed.
Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. MMWR Morb Mortal Wkly Rep. 2008;57(45):1226-1228.
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults - United States, 2005-2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1205-1211. doi:10.15585/mmwr.mm6544a2
Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults and trends in smoking cessation - United States, 2008. MMWR Morb Mortal Wkly Rep. 2009;58(44):1227-1232.
Boudreaux ED, Baumann BM, Friedman K, Ziedonis DM. Smoking stage of change and interest in an emergency department-based intervention. Acad Emerg Med. 2005;12(3):211-218. doi:10.1111/j.1553-2712.2005.tb00871.x
Bernstein SL, D’Onofrio G, Rosner J, et al. Successful tobacco dependence treatment in low-income emergency department patients: a randomized trial. Ann Emerg Med. 2015;66(2):140–147. doi:10.1016/j.annemergmed.2015.03.030
Berstein SL, Boudreaux ED, Cydulka RK, et al. Tobacco control intervention in the emergency department: a joint statement of emergency medicine organizations. Ann Emerg Med. 2006;48(4):e417–e426. doi:10.1016/j.annemergmed.2006.02.018
Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews. 2013;5. doi:10.1002/14651858.cd000165.pub4
Bae J, Ford EW, Huerta TR. The Electronic Medical Record's Role in Support of Smoking Cessation Activities. Nicotine Tob Res. 2016;18(5):1019-1024. doi:10.1093/ntr/ntv270
Boyle R, Solberg L, Fiore M. Use of Electronic Realth Records to Support Smoking Cessation. Cochrane Database of Systemic Reviews. 2014;12. doi:10.1002/14651858.cd008743.pub3