Cigarette smoking is the leading cause of preventable death in the United Stales, accounting for approximately 440,000 deaths from smoking‐attributable illness each year. Smokers hospitalized for acute illnesses may be more receptive to smoking cessation counseling, and prior research has shown that smoking cessation interventions initiated in the inpatient setting can increase a hospitalized patient's likelihood of quitting. However, inpatient providers offer smoking cessation counseling and nicotine replacement therapy (NRT) to hospitalized smokers inconsistently, We developed a peer‐led educational intervention built around audit and feedback to improve the frequency of inpatient smoking cessation counseling, the documentation of smoking as a health problem, and the appropriateness of NRT dosing by hospitalist practitioners in our hospital.
A pre‐post study design was utilized 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 electronic medical record (EMR), and all admission and progress notes as well as discharge summaries for smokers were reviewed. From each record, information on counseling and initiation of appropriate NRT treatment was collected. A profile was then assembled for each individual hospitalist. In 1‐hour one‐on‐one sessions, feedback was given to the hospitalists about their prior performance, educational materials were shared, and instruction was provided on the optimal way to deliver counseling 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 30 hospitalist providers. Considered for this analysis were 545 and 1119 patient‐days in the pre‐ and postintervention periods, respectively. Documentation of tobacco‐dependence counseling in progress notes increased from 36% to 44% (P = 0.002), and documentation of tobacco dependence as a health problem in discharge summaries increased from 8% to 47% (P < 0.0001). The proportion of patient encounters where eligible patients were offered NRT increased from 15% to 26% (P < 0.0001), and the appropriateness of NRT dosing increased from 26% before the intervention to 64% in the follow‐up period (P < 0.0001).
A peer‐led educational session for hospitalists based on audit and feedback can enhance the documentation and quality of smoking‐cessation interventions for hospitalized smokers. It is our hope that this improvement will translate into continued abstinence following hospital discharge.
F. Kisuule, none; A. Necochea, none; E. Howe, none; S. Wright, none.
To cite this abstract:Kisuule F, Necochea A, Howe E, Wright S. Utilizing Audit and Feedback to Improve Hospitalists' Performance in Tobacco‐Dependence Counseling. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 79. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/utilizing-audit-and-feedback-to-improve-hospitalists-performance-in-tobaccodependence-counseling/. Accessed March 30, 2020.