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

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

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

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

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

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

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

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

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)