title: Emergency department tobacco cessation program: staff participation and intervention success among patients.
abstract: BACKGROUND
  The emergency department (ED) is often the primary source of healthcare for uninsured and underinsured patients.
  
  
  OBJECTIVE
  To evaluate ED staff attitudes toward and participation in referring patients to a tobacco cessation program, and to assess the program's effectiveness.
  
  
  METHODS
  A nonvalidated survey on smoking cessation and preventative services for ED patients was mailed to ED staff at a suburban hospital. After survey completion, ED staff was encouraged to refer smokers with diagnoses substantially worsened by tobacco use to a brief intervention delivered in the ED. An incentive was provided to staff beginning in the second month of the 3-month period. Referred patients were briefly counseled by a hospital social worker or an ED physician or nurse. Follow-up telephone interviews with patients occurred 1 to 3 months postintervention.
  
  
  RESULTS
  Of the 70 ED staff contacted, 63 (90%) responded to the survey. Most staff members (81%) agreed that they should facilitate clinical prevention. Fewer staff (60%) were comfortable advising patients to quit tobacco use (P<.03), and fewer still (51%) agreed that ED staff should assist patients in tobacco cessation (P<.001). Tobacco users were more likely to favor implementing patient education in the ED (P=.01) and were less comfortable advising patients to quit (P=.06). Staff referrals increased with program incentives (P=.008), with a total of 150 interventions occurring in the 3-month span. Of the 36 patients (24%) reached for follow-up, 13 (36%) attempted to quit and 6 (17%) succeeded. Overall, 45% of the patients reached for follow-up either cut down or quit tobacco use.
  
  
  CONCLUSIONS
  Staff members' attitudes toward tobacco cessation are not a firm barrier to the successful implementation of an ED tobacco cessation program. In addition, the ED provides an important opportunity to encourage patients to quit or cut down tobacco use.
authors: Lehigh Valley Hospital, Allentown, PA 18103-6980, USA. mrgdo@ptd.net
authors: Marna Rayl
authors: MR
authors: Greenberg
authors: Michael
authors: M
authors: Weinstock
authors: Deborah Gaston
authors: DG
authors: Fenimore
authors: Gina M
authors: GM
authors: Sierzega
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration; D010817:Physician-Patient Relations; D011336:Probability; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires