Abstract 2291: The Impact of a Collaborative Approach to Smoking Cessation Counseling for Cardiac Patients
Background: Smoking Cessation (SC) is essential to patient management. ACC/AHA guidelines state that patients who smoke are at increased risk for heart failure (HF) or myocardial infarction (MI), and should receive SC counseling during hospitalization.
Methods: An interdisciplinary team was formed to ensure that a patient identified as a smoker receives intervention. In June 2004 an Admission Referral process, which prompts bedside nurses to ask patients on admission if they have smoked tobacco in the past year, was implemented. SC materials are provided and if necessary, a trained SC team member assesses smokers’ readiness to quit and provides nicotine replacement therapy. Success of this approach for MI and HF patients was monitored using data collected for the Quality Indicator sets, and interrupted time series analyses.
Results: Prior to June 2004, 97% of MI (n=183) and 68% of HF (n=57) smokers were counseled to quit. Compliance rates for HF improved to 80% after implementation of the admission referral form, but decreased to 93% for MI. After standardization of documentation methods, SC counseling has been consistently provided to 100% of MI smokers, 100% of HF smokers with cardiology attending physicians, and to 95% of patients with non-cardiologist attendings. Initial results following standardization of discharge instructions for all patients indicates 100% compliance for HF patients.
Conclusions: A collaborative team approach and standardization of processes is successful in identifying patients who smoke and assuring that SC counseling is provided during hospitalization.