Introduction ED admissions are ‘teachable moments’ to offer cessation advice to smokers. In this study, smoking prevalence and stop smoking interventions were investigated in patients admitted to ED in a busy inner London hospital. The views of ED doctors on the value/appropriateness of offering smoking cessation advice in ED were canvassed with the aim of defining barriers to implementation of ‘right care’ for sick smokers.
Methods Proforma questionnaires guided interviews of ED patients and doctors. Patient demographics, smoking history (pack years, quit attempts, motivation to quit, smoking cessation advice/referral in ED) were documented. Doctors were asked about their views on ascertaining smoking status, offering brief advice and referral to quit smoking services to smokers in ED. All patients and staff were given an information sheet explaining the purpose of the questionnaires.
Results 101 patients were interviewed. 24/101(23%) were current smokers (3/24 12.5% also smoked cannabis), 39/101(39%) were ex-smokers and 38/101(37%) were lifelong non-smokers. Table 1 demonstrates that smokers were younger than ex- and never-smokers, never-smokers were predominantly female and 17/24 (71%) smokers had had multiple attempts to give up. In comparison, 36/39 (92%) ex-smokers gave up on their first attempt, with 33/39(85%) quitting without assistance. 13/24(54%) smokers expressed a desire to quit yet only 4(17%) were asked/given advice about smoking by a doctor. 14 doctors (6 FYs, 4 CMT/SPRs, 4 consultants, 8/14 had had Stop Smoking training) were questioned. 14/14 agreed that smoking cessation was important; 8/14(57%) felt that ED was not an appropriate place to offer advice.
Conclusion 1/4 of patients attending A+E are smokers. Over 1/2 are motivated to quit but are not offered smoking-cessation advice during admission. Despite ED staff regarding Stop Smoking as valuable treatment, there is a perception that ED is an inappropriate setting to broach the issue of quitting. Smokers tended to be younger and had multiple unsuccessful attempts to quit compared to older ex-smokers who mainly quit on the first attempt. Offering support to quit during the first attempt is the most effective way to achieve permanent cessation. ED attendance should therefore be prioritised for targeted stop smoking interventions.
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