SHORT REPORT
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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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
CORRESPONDING AUTHOR
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
KEYWORDS
TOPICS
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 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.

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.

ACKNOWLEDGEMENTS
The manuscript was copyedited by L.J. Kesselring.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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