Smoking cessation for patients with pulmonary issues is of the utmost importance to improving their health. A tobacco treatment specialist (TTS) is currently employed for several outpatient clinics, offering counseling and support to patients contemplating smoking cessation. Several limitations existed for an efficient and comprehensive referral process. The existing referral process for getting patients in touch with the TTS was provider-driven. Referrals were only placed for patients who discussed their smoking status and readiness to quit with their provider. Provider awareness of TTS services was lacking, and the referral itself was not intuitive to find within the electronic health record (EHR). For these reasons, many eligible patients did not receive referrals to the TTS.
The purpose of this project was to increase access to the TTS for pulmonary clinic patients by utilizing a nurse-driven protocol to refer all active smokers for smoking cessation counseling and initiating a nurse outreach workflow to discuss readiness to quit with patients.
The nurse-driven protocol was created to allow nurses to identify any eligible patients seen within the pulmonary clinic and place a referral to the TTS for smoking cessation counseling. The protocol defined eligible patients as those whom have been seen within the clinic in the last calendar year with an active smoking status. The new workflow for nurse outreach enabled nurses to assess readiness to quit and provide patients with education on services offered by the TTS. All patients referred to the TTS by the nurse-driven protocol and contacted as part of the nurse outreach workflow were tracked to determine whether an appointment had been scheduled with the TTS. Retrospective chart audits were also completed to determine how many eligible patients received referrals to the TTS and ultimately scheduled their appointment prior to the nurse-driven protocol and nurse outreach beginning.
With the implementation of the nurse-driven protocol and nurse outreach workflow, the percentage of active smokers seen within the pulmonary clinic whom received referrals to the TTS increased by 18.2%. The number of visits with the TTS increased by 36%. Patients who were contacted via nurse outreach were 35% more likely to schedule an appointment or consultation with the TTS.
Increasing access to the TTS utilizing the nurse-driven protocol and promoting nurse outreach to discuss readiness to quit allows clinic nurses to practice at the top of their scope. Future implications for this project include expanding nurse outreach to patients who have established care with the TTS to promote adherence to smoking cessation counseling, and ultimately increase the number of patients who successfully quit smoking.