1. Implementing an Automated Quitline Referral in a Large Academic Emergency Department
Georges J. Nahhas, PhD, MPH
Postdoctoral Scholar
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Nov 9, 2016

3. Goal: implement a low cost system to identify smokers and connect them to the SC Tobacco Cessation Quitline

4. MUSC Tobacco Cessation Policy
The Joint Commission (JC) recommends that all current smokers receive tobacco cessation services as an inpatient and be followed up within one month after hospital discharge
In 2014, MUSC implemented an inpatient smoking cessation service consistent with JC standard

5. 3-Step Intervention Screening
All patients were asked about tobacco at admission
All current tobacco users were referred to the tobacco cessation service
Those eligible for bedside counseling scheduled for a visit
Counselling
A detailed tobacco history and a treatment plan recommendation documented in TelASK Quit Manager database via tablet devices
Follow-Up
IVR phone follow-up assessment at 3, 14, 30, 90, & 180 days after discharge

6. Inpatient Services (Feb 2014-Mar2016)
66290 adult admissions screened (excluding IOP)
11228 (17%) current smokers identified
Of those approached by bedside counsellor 84% (2566) accepted the consult
7131 smokers were eligible for phone follow-up
3306/7131 (46%) were reached by phone within 1 month of discharge
Bedside counselling increased post-discharge NRT uptake by over 3-folds
Bedside counselling nearly doubled post-discharge quit rates
TelASK hired to install the Quit Manager system, work with MUSC IT department to arrange for secure data transfers, make IVR follow-up calls, and track data
Program launched February 2014 with 1 dedicated bedside counselor
January 2016 a 2nd bedside counselor was hired

8. Emergency Department (June-July 2016)
5471 low acuity patients discharged home
1601 (29%) current smokers
Sex: 58% males; 42% females
Race: 56% black, 41% white
Insurance: 21% Medicaid, 47% uninsured
30% reached by phone within 30 days
10% reached by phone within 90 days

9. Emergency Department (June-July 2016)
11% were connected with the SC quitline
3% made a quit attempt
1% were abstinent from smoking
<1% were using stop-smoking medications

10. Next Steps… Inpatient Services: Emergency Department:
Evaluation of the cost-effectiveness of the service with a focus on clinical outcomes such as hospital readmissions
Emergency Department:
R21 grant to evaluate a scalable low-cost dissemination of stop-smoking medication

11. Thank you!
Quality Executive Committee Graham Warren, MD PhD (on behalf of tobacco assessment committee) K. Michael Cummings PhD Benjamin Toll PhD Phil Smeltzer PhD Katherine Hoover PharmD Georges Nahhas PhD TelASK (Vince and Peter)