title: The emergency department action in smoking cessation (EDASC) trial: impact on cessation outcomes.
abstract: BACKGROUND
  The focus on acute care, time pressure, and lack of resources hamper the implementation of smoking cessation guidelines in the emergency department (ED). The purpose of this study was to determine whether an emergency nurse- initiated intervention based on the 5A's (Ask-Advise-Assess-Assist-Arrange) framework improves quit rates.
  
  
  METHODS
  We conducted a pre-post implementation trial in 789 adult smokers who presented to two EDs in Iowa between August 13, 2008 and August 4, 2010. The intervention focused on improving delivery of the 5A's by ED nurses and physicians using academic detailing, charting/reminder tools, and group feedback. Performance of ED cessation counseling was measured using a 5A's composite score (ranging from 0 to 5). Smoking status was assessed by telephone interview at 3- and 6-month follow-up (with biochemical confirmation in those participants who reported abstinence at 6-month follow-up).
  
  
  RESULTS
  Based on data from 650 smokers who completed the post-ED interview, there was a significant improvement in the mean 5A's composite score for emergency nurses during the intervention period at both hospitals combined (1.51 vs. 0.88, difference = 0.63, 95% confidence interval [CI] [0.41, 0.85]). At 6-month follow-up, 7-day point prevalence abstinence (PPA) was 6.8 and 5.1% in intervention and preintervention periods, respectively (adjusted odds ratio [OR] = 1.7, 95% CI [0.99, 2.9]).
  
  
  CONCLUSIONS
  It is feasible to improve the delivery of brief smoking cessation counseling by ED staff. The observed improvements in performance of cessation counseling, however, did not translate into statistically significant improvements in cessation rates. Further improvements in the effectiveness of ED cessation interventions are needed.
authors.affiliation: Department of Medicine, University of Iowa, Iowa City, IA, USA. david-katz@uiowa.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Katz
authors.forename: John E
authors.initials: JE
authors.lastname: Holman
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Nugent
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Baker
authors.forename: Skyler R
authors.initials: SR
authors.lastname: Johnson
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Hillis
authors.forename: David G
authors.initials: DG
authors.lastname: Tinkelman
authors.forename: Marita G
authors.initials: MG
authors.lastname: Titler
authors.forename: Mark W
authors.initials: MW
authors.lastname: Vander Weg
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003376:Counseling / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education*; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D016896:Treatment Outcome; D055815:Young Adult