You are here

Rationale and Benefits of Treating Tobacco Use in the Hospital Setting

Gold Standard  Employer: Vanderbilt University Medical Center

Smoking is the leading cause of preventable disease and death in the United States. Initiating treatment during hospital admission increases long-term quit rates by 40% or higher. Smoking cessation results in fewer hospital readmissions, fewer total hospital days, and lower smoking-related morbidity as well as elevated quality of life that is sustained for years after the quit date. 

Identification of Tobacco Use Status - Hilary Tindle, MD (Director, Center for Tobacco, Addiction and Lifestyle, Vanderbilt University Medical Center) and team have recently updated and revised the Vanderbilt Nurse Admission Note (RAN) that went into effect in July of 2015 at Vanderbilt University Medical Center. This overhaul is designed to comprehensively address tobacco use status and bring Vanderbilt into alignment not only with CMS MU Stage 2, but also the more stringent Joint Commission tobacco measures 1-3, which are currently in evolution. Vanderbilt is represented on the Joint Commission's electronic Clinical Quality Measures (e-CQM) Tobacco Task Force, and is actively shaping these measures, which include granular assessment of cigarettes per day, recent quit attempts (for current smokers), duration of abstinence (for former smokers), and use of other types of tobacco products such as electronic cigarettes, cigars, and smokeless tobacco. This information from the Nurse Admission Form identifies tobacco users. In 2014, there were 5652 individuals identified as smokers via the RAN who were inpatients. These individuals will be targeted for automatic comprehensive treatment by the Tobacco Treatment Service, which is expected to be hospital-wide in 2016.

Inpatient Tobacco Treatment Service - The Vanderbilt Tobacco Treatment Service (TTS) is a clinical inpatient service that provides evidence-based care to tobacco users who are hospitalized. The TTS employs Certified Tobacco Treatment Specialists who proactively visit patients identified from the Electronic Health Record (HER) as current or recently former smokers (quit within past month and at high risk of relapse). The TTS Specialists assess patients' tobacco use patterns and then counsel and recommend smoking cessation pharmacotherapy to manage nicotine withdrawal and promote long term cessation. The TTS expects to encounter approximately 3000 unique tobacco users annually. 

Post-discharge Follow up Care - To achieve better long term continuity of care the TIS will utilize a bi­directional electronic ("e-Referral") to the TN State Quitline. All hospitalized smokers seen by the TTS are offered eReferral, and those who accept are called by the state quitline tobacco treatment specialists within 2 days of hospital discharge. To address the challenges associated with patient follow-up after hospital discharge, the TTS is currently working with WestCorp to develop automated calls to all identified smokers via Inter-active Voice Recognition (IVR). IVR calls extend the therapeutic encounter after discharge by assessing tobacco use status and offering eReferral for those patients who had not yet connected with the state quitline. IVR can also promote use of proven FDA-approved smoking cessation medications. 

Tobacco Control Order Set -The Vanderbilt Tobacco Control Order Set features all 7 FDA-approved medications from and reference text and guidelines on their use. The TTS is currently working with other 
Vanderbilt colleagues to facilitate smoking cessation medication on the discharge medication list (i.e., beyond 
the inpatient stay). This order set is designed to facilitate the use of efficacious smoking cessation medications, and will be utilized by the Tobacco Treatment Service counselors and all hospital prescribers.