When residents are exposed to tobacco‐dependence treatment (TDT) training, the teachings are mainly geared toward performing such practice in outpatient settings. However, hospitalized smokers may be more responsive to smoking cessation interventions than nonhospital‐iied smokers. In fact, the Joint Commission will likely soon start to track not just if hospitalized smokers were asked about smoking, but if treatments were prescribed. With this in mind, we developed an attending‐led educational intervention for internal medicine interns in our hospital, built around audit of electronic medical records (EMR) and feedback. Goals of the program were (1) to improve the frequency of documented TDT for hospitalized smokers and (2) to increase the number of patients prescribed nicotine replacement therapy (NRT) at appropriate doses.
A pre‐post study design was used to assess the appropriateness of NRT, as well as the documentation of counseling and treatment for tobacco dependence. In the preintervention period, an audit was performed of the EMR and all admission, progress, and discharge summary notes for smokers were reviewed. From each record, information on TDT and initiation of NRT was collected. A profile was then assembled for each individual intern. In 1‐hour one‐on‐one sessions, feedback was given to the interns about their performance, educational materials were shared, and instruction was provided on the optimal way to deliver TDT through simulated patient interviews. Following the intervention, an audit was again performed of the EMR, collecting the same data from the charts of admitted smokers.
Information was obtained for 17 internal medicine interns. Data from 196 and 187 patients were included in this analysis in the pre‐ and postintervention periods, respectively. Documentation of tobacco dependence in admission and progress notes increased from 23% before to 54% after the intervention (P < 0.0001). The proportion of discharge summaries with documented follow‐up for TDT increased from 32% to 50% (P = 0.0007). The number of patients eligible for initiation of NRT was similar in the pre‐ and postintervention periods, but the proportion of patients offered NRT increased from 14% to 33% (P < 0.0001) No statistically significant difference was observed in the proportion of patients who accepted the offered NRT (70% before. 71% after) or in the appropriateness of NRT dosing following the intervention (61% before, 59% after).
An attending‐led educational session based on audit of EMR and feedback can be a valuable tool to enhance documented TDT among internal medicine interns in the inpatient setting and to increase the number of hospitalized smokers prescribed NRT. Further studies will determine whether these practices can positively influence smoking cessation.
A. Necochea, none, F. Kisuule, none, S. Wright, none.
To cite this abstract:Necochea A, Kisuule F, Wright S. Audit of Electronic Health Records and Feedback Improves Medicine Interns' Performance in Inpatient Tobacco‐Dependence Treatment. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 101. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/audit-of-electronic-health-records-and-feedback-improves-medicine-interns-performance-in-inpatient-tobaccodependence-treatment/. Accessed April 9, 2020.