Implementation of smoking cessation guidelines in the emergency department

a qualitative study of staff perceptions.

David A. Katz, Monica W. Paez, Heather S. Reisinger, Meghan T. Gillette, Mark W Vander Weg, Marita G. Titler, Andrew S. Nugent, Laurence J. Baker, John E. Holman, Sarah Ono

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians' (EPs) and nurses' (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A's framework (Ask-Advise-Assess-Assist-Arrange) in the ED. We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts. The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients' receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A's in the ED. There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies. ClinicalTrials.gov registration number NCT00756704.

Original languageEnglish (US)
Pages (from-to)1
Number of pages1
JournalAddiction science & clinical practice
Volume9
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Smoking Cessation
Hospital Emergency Service
Guidelines
Counseling
Nurses
Emergencies
Physicians
Preventive Medicine
United States Public Health Service
Workflow
Tobacco Use
Practice Guidelines
Prescriptions
Primary Health Care
Patient Care
Referral and Consultation
Interviews

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Implementation of smoking cessation guidelines in the emergency department : a qualitative study of staff perceptions. / Katz, David A.; Paez, Monica W.; Reisinger, Heather S.; Gillette, Meghan T.; Weg, Mark W Vander; Titler, Marita G.; Nugent, Andrew S.; Baker, Laurence J.; Holman, John E.; Ono, Sarah.

In: Addiction science & clinical practice, Vol. 9, 2014, p. 1.

Research output: Contribution to journalArticle

Katz, David A. ; Paez, Monica W. ; Reisinger, Heather S. ; Gillette, Meghan T. ; Weg, Mark W Vander ; Titler, Marita G. ; Nugent, Andrew S. ; Baker, Laurence J. ; Holman, John E. ; Ono, Sarah. / Implementation of smoking cessation guidelines in the emergency department : a qualitative study of staff perceptions. In: Addiction science & clinical practice. 2014 ; Vol. 9. pp. 1.
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