title: Feasibility of Implementing a Hospital-Based "Opt-Out" Tobacco-Cessation Service.
abstract: OBJECTIVE
  To assess the feasibility and outcomes of implementing a hospital-based "opt-out" tobacco-cessation service.
  
  
  METHODS
  In 2014, the Medical University of South Carolina adopted a policy that all hospitalized patients who self-report using tobacco be referred to tobacco-cessation service. This is a descriptive study of a real-world effort to implement guidelines for a hospital-based cessation service consistent with Joint Commission's standards. Between February 2014 and May 2015, 42 061 adults were admitted to the Medical University of South Carolina Hospital. Eligible current cigarette smokers were referred to the tobacco-cessation service, which consisted of a bedside consult and phone follow-up 3, 14, and 30 days after hospital discharge using interactive-voice-response. The primary study outcomes evaluated the proportions of smokers reached by the bedside counselor and/or phone follow-up, smokers who opted out, and smokers who self-reported not smoking when last contacted by phone.
  
  
  RESULTS
  Records identified 8423 smokers, of whom 69.4% (n = 5843) were referred into the service. One full-time bedside counselor was able to speak with 1918 (32.8%) patients, of whom 96 (5%) denied currently smoking and 287 (14.9%) refused counselling. Reach at follow-up was achieved for 703 (55%) smokers who received bedside counselling and 1613 (49%) who did not, yielding an overall follow-up reach rate of 60%. Of those reached by phone, 36.4% reported not smoking (51% vs. 27% for those who did and did not receive bedside counselling, respectively). Intent-to-treat abstinence rate was 13.5% according to the last known smoking status.
  
  
  CONCLUSIONS
  Findings from this study suggest that an inpatient smoking-cessation service with an "opt-out" approach can positively impact short-term cessation outcomes.
  
  
  CONCLUSIONS
  (1) The findings demonstrate the feasibility of implementing an automated large-scale opt-out tobacco-cessation service for hospitalized patients that is consistent with the Joint Commission recommended standards for treating tobacco dependence. (2) Receiving a bedside tobacco-cessation consult while hospitalized increased the use of stop smoking medications and abstinence from smoking after discharge from the hospital. (3) Even in those patients who did not receive a bedside consult, 5% accepted a referral to the South Carolina Tobacco Quitline to get help to stop smoking.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Georges J
authors.initials: GJ
authors.lastname: Nahhas
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Dianne
authors.initials: D
authors.lastname: Wilson
authors.affiliation: TelASK Technologies Inc., Ottawa, Canada.
authors.forename: Vince
authors.initials: V
authors.lastname: Talbot
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Cartmell
authors.affiliation: Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC.|Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Toll
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carpenter
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D006760:Hospitalization; D006801:Humans; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D013022:South Carolina; D016896:Treatment Outcome