"Implementation of a quality improvement project on smoking cessation reduces smoking in a high risk trauma patient population" by Jeffry Nahmias, MD

Article

Implementation of a quality improvement project on smoking cessation reduces smoking in a high risk trauma patient population

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Jeffry Nahmias, MD, Baystate Health
Andrew Doben, Baystate Health
Shiva Poola, MD, Baystate Health
Karen Carrens, Baystate Health
Ronald Gross, Baystate Health

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Document Type

Article, Peer-reviewed

Publication Date

4-1-2016

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND:

Cigarette smoking causes about one of every five deaths in the U.S. each year. In 2013 the prevalence of smoking in our institution's trauma population was 26.7 %, well above the national adult average of 18.1 % according to the CDC website. As a quality improvement project we implemented a multimodality smoking cessation program in a high-risk trauma population. METHODS:

All smokers with independent mental capacity admitted to our level I trauma center from 6/1/2014 until 3/31/2015 were counseled by a physician on the benefits of smoking cessation. Those who wished to quit smoking were given further counseling by a pulmonary rehabilitation nurse and offered nicotine replacement therapy (e.g. nicotine patch). A planned 30 day or later follow-up was performed to ascertain the primary endpoint of the total number of patients who quit smoking, with a secondary endpoint of reduction in the frequency of smoking, defined as at least a half pack per day reduction from their pre-intervention state. RESULTS:

During the 9 month study period, 1066 trauma patients were admitted with 241 (22.6 %) identified as smokers. A total of 31 patients with a mean Injury Severity Score (ISS) of 14.2 (range 1-38), mean age of 47.6 (21-71) and mean years of smoking of 27.1 (2-55), wished to stop smoking. Seven of the 31 patients, (22.5 %, 95 % confidence interval [CI] of 10-41 %) achieved self-reported smoking cessation at or beyond 30 days post discharge. An additional eight patients (25.8 %, 95 % CI 12-45 %) reported significant reduction in smoking. CONCLUSIONS:

Trauma patients represent a high risk smoking population. The implementation of a smoking cessation program led to a smoking cessation rate of 22.5 % and smoking reduction in 25.8 % of all identified smokers who participated in the program. This is a relatively simple, inexpensive intervention with potentially far reaching and beneficial long-term health implications. A larger, multi-center prospective study appears warranted. LEVEL OF EVIDENCE:

Therapeutic Study, Level V evidence.

PMID

27118989

Citation Information

Nahmias J, Doben A, Poola S, Korntner S, Carrens K, Gross R. Implementation of a quality improvement project on smoking cessation reduces smoking in a high risk trauma patient population. World J Emerg Surg. 2016 Apr 26;11:15.