Identifying and Referring Hospitalized Smokers in Rural Communities

Audience: Clinicians, Administrators

Key Points: Hospitalization has been identified as a unique opportunity to address smoking cessation, but implementation of hospital smoking cessation programs has been inconsistent.  Development of smoking cessation programs may be particularly difficult in small rural hospitals where resources may not be available to have dedicated smoking cessation staff.  We sought to assess the feasibility of implementing identification and fax referral programs for smokers in rural hospitals.  We recruited 22 rural hospitals in Kansas to participate in a clinical trial in which they would identify smokers and offer them fax referral to a study of alternative smoking cessation counseling programs.  Each hospital was supplied with fax referral forms and participated in continuing education programs for nurses and physicians.   Following program implementation, we reviewed a random sample of charts at each of the participating hospitals.  We completed chart reviews on 1,759 hospitalized patients with 327 (18.6% (range:  12-27%)) identified as smokers.   Of smokers, 196 (60% (range 0-100%) were approached about fax referral and 49 (15% (range 0-50%) agreed to be referred.  The hospitals with the highest referral rates had transitioned the referral procedures into existing patient care processes.   

Educational Experience: Poster presentation with 1:1 discussion.

Benefits: Participants will see that a high proportion of patients in rural hospitals are smokers.  Although only a minority of these smokers agree to fax referral to treatment, high variability in referral rates suggest opportunities for improvement.