Does your next patient want to quit smoking?

Many ED patients say they want an intervention

As an ED nurse, you are in a unique position to do two things: Assess tobacco use, and assess the patient’s interest in quitting. 

"Such interventions take very little time and have a huge potential impact on patient health," says Jon O. Ebbert, MD, assistant professor of medicine at the Mayo Clinic College of Medicine in Rochester, MN.

Researchers interviewed 376 current tobacco users in the ED of Saint Marys Hospital at the Mayo Clinic in Rochester during a three-week period in 2003. The study found that 73% of patients who were interested in receiving a tobacco use intervention reported that they would like all or part of it to be done after ED discharge, such as telephone-based counseling in their homes.1

"The population of patients that visit our nation’s EDs have high rates of tobacco use, and almost half of them have an interest in quitting," says Ebbert, one of the study’s authors. A recent Boston study had similar findings, with researchers reporting that 72% of current smokers had tried to quit in the past year and 33% wanted an outpatient referral.2

"Ask about smoking and gently inquire whether current smokers are trying to quit," recommends Carlos Camargo, MD, one of the study’s authors and an ED physician at Massachusetts General Hospital in Boston. "Provide encouragement for those who are trying to quit smoking." Regardless of the patient’s answer, emphasize how important smoking cessation is for good health, he adds.

Say the following to patients, advises Edwin D. Boudreaux, MD, PhD, ED researcher at Cooper University Hospital in Camden, NJ, and lead author of the Boston study:

  • "Have you smoked any cigarettes or cigars in the past 30 days?"
  • "Quitting smoking is the best thing you can do for your health." If the patient came to the ED for asthma exacerbation, chronic obstructive pulmonary disorder, myocardial infarction, or pneumonia, add, Your ED visit is probably related to your smoking," he recommends.

ED nurses at Saint Marys Hospital in Rochester, MN, offer current smokers nicotine alternatives such as gum, lozenges, and inhalers, says Janet L. Finley, RN, MS, clinical nurse specialist for the ED. "The amount is based on how much they smoke and how soon the patient smokes their first cigarette upon waking."

Patients also are given a smoking cessation information packet and offered a nicotine dependency consult at a local center, Finley says. If patients are admitted to the ED’s observation area, the consult occurs there, she says.

Tobacco use interventions may not be possible in the ED because of limited time and resources, but the researchers all suggest a simple and quick intervention: Give patients a referral to tobacco counseling hotlines. "Few patients attend outpatient clinic visits for tobacco treatment, but many patients appear amenable to telephone-based counseling interventions," says Ebbert. "This may be the best option we have."

The intervention can be as simple as handing patients a business card that says "Interested in quitting smoking? Call 1-800-QUITNOW," says Ebbert. This number will triage patients to their state tobacco quitline based upon the area code from which they are calling, he explains.

Services offered by tobacco quitlines vary by state, but all involve the opportunity to speak with a counselor, says Ebbert. "A growing number of states are providing medications at low cost or no cost to all or some of their callers," he reports.

References

  1. Klinkhammer MD, Patten CA, Sadosty AT, et al. Motivation for stopping tobacco use among emergency department patients. Acad Emerg Med 2005; 12:568-571.
  2. Boudreaux ED, Kim S, Hohrmann JL, et al. Interest in smoking cessation among emergency department patients. Health Psychol 2005; 24:220-224.

Sources/Resource

For more information on smoking cessation in the ED, contact:

  • Edwin D. Boudreaux, PhD, Emergency Medicine, Cooper University Hospital, One Cooper Plaza. Camden, NJ 08103. Telephone: (856) 757-7801. Fax: (856) 757-9651. E-mail: Boudreaux-Edwin@cooperhealth.edu.
  • Carlos A. Camargo, MD, DrPH, Director, EMNet Coordinating Center, Massachusetts General Hospital, 326 Cambridge St., Suite 410, Boston, MA 02114. E-mail: ccamargo@partners.org.
  • Jon O. Ebbert, MD, Assistant Professor of Medicine, Mayo Clinic College of Medicine, 200 First St. S.W., Rochester, MN 55905. Telephone: (507) 255-3965. Fax: (507) 266-7900. E-mail: ebbert.jon@mayo.edu.
  • Janet L. Finley, RN, MS, Clinical Nurse Specialist, Emergency Department, Saint Marys Hospital, 1216 Second St. S.W., Rochester, MN 55902. Telephone: (507) 255-8086. Fax: (507) 255-9929. E-mail: finley.janet@mayo.edu.

For a telephone helpline that serves as a single access point to the National Network of Tobacco Cessation Quitlines, go to www.smokefree.gov. Click on "Get telephone support." Callers speak with a counselor, receive information materials, and obtain referrals to other resources.