To increase the percentage of referrals of current smokers to the Tobacco Dependency Team by 50% in the Respiratory Wards over a 2-week period. Our goal was to improve patient outcomes by enabling continuity of care.
Smoking tobacco is a uniquely dangerous and addictive behaviour which has killed millions in the UK alone. There is extensive evidence displaying highly effective interventions that can help people reduce or quit smoking. However, the rate of inpatient Tobacco Dependency Team referrals was too low. Therefore, an interventions designed to mitigate this problem could reduce the rate long-term smokers, reducing the rate of side-effects/complications therefore reducing the rate of inpatient admissions. This would help patients live longer and healthier lives but would also reduce burden on staff and on bed capacity by potentially reducing the number of patients.
We measured the numbers of patients who were smokers on admission or just before admission. We then calculated the efficacy of existing tobacco dependency team referrals by noting how many of those patients were asked, offered a referral, and then referred to the Tobacco Dependency Team and expressed that as a percentage. This data was collected by two F1s who visited the Respiratory Wards and asked patients or checked AMU clerking booklets. We planned to measure success by measuring and calculating the increase in the percentage of successful referrals after our intervention.
We used a few methods to convey the process behind smoking cessation referrals. Through the use of posters detailing the referral pathway combined with face to face teaching we were able to educate the relevant professionals. We targeted both junior doctors and ward clerks, updating them on the tobacco dependency team, their role and the referral process. We went onto collect our pre and post intervention data and compare the uptake. Our project was structured around our smart aims set out prior to commencement.
Unfortunately we were not able to meet our target of 50 % increase in referral rates. The referral rate prior to our intervention was 40 % and post intervention it was 12 % resulting in a 28 % decrease. Our results were affected by various factors: junior doctors being extremely busy and low staffing levels, not all the staff received face to face training, the poster contained too much information are some of the confounding factors. We hope to learn from this project and approach it differently for our next cycle.
We hope to carry out our next cycle over a longer period of time to increase the number of data points hence make our data less skewed by confounding factors. We learnt the importance of involving all the staff members who are based on the ward. Making an interactive quick teaching prior to the junior doctor respiratory teaching that happens every Tuesday will help us overcome this challenge. We hope to expand our data collection over more medical wards and use more eye catching, succinct posters. The next phase of our project hopes to look at the prescription of NRT in those patients who have been referred to the tobacco dependency team and evaluate the prescriptions to identify any discrepancies against the guidelines.