JHQ 315: Improving Ambulatory Smoking Cessation Counseling Across a Large Academic Internal Medicine Department-JHQ 315 Article

JHQ 315 Article

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This article describes a department-wide quality improvement (QI) initiative to increase ambulatory smoking cessation counseling (SCC) and referrals to a nicotine cessation program (NCP) across a large academic internal medicine department. Smoking remains a leading preventable cause of death, yet many smokers are not counseled during healthcare visits despite strong interest in quitting.

The intervention targeted adult <strong>new patients</strong> (not seen in the prior 3 years) who were <strong>current smokers</strong> across <strong>52 internal medicine outpatient clinics</strong> over <strong>12 months (Sept 2022–Aug 2023)</strong>. The project used a Plan-Do-Study-Act (PDSA) framework and tied performance to a <strong>faculty financial incentive</strong>. A composite metric—documentation of SCC and/or an NCP referral—had a low baseline of <strong>8.6%</strong>.

Key low-cost strategies to drive adoption included: leadership emails, a <strong>monthly QI newsletter</strong>, a <strong>workflow infographic</strong>, presentations at division faculty meetings, and targeted outreach to low-performing clinics. The recommended workflow was staff-driven: during intake, medical office assistants/nurses identified smokers, offered an NCP referral, pended the referral for provider signature if accepted, or added cessation materials to the after-visit summary if declined; SCC was documented via a discrete EHR “counseling given” field. Performance was tracked monthly via an Epic-to-Tableau dashboard.

Results showed that among <strong>1,773</strong> eligible smokers, the composite counseling/referral rate increased from <strong>8.6% to 25.6%</strong> (about a threefold improvement). NCP referrals rose during the first half of the year but were not sustained later; only about <strong>26%</strong> of referrals resulted in an NCP visit. Limitations included single-center design, capture of only one encounter per patient, variable clinic workflows, and reliance on documentation rather than confirmed counseling or quit outcomes.

Keywords

quality improvement initiative

ambulatory smoking cessation counseling

nicotine cessation program referral

internal medicine outpatient clinics

new patient current smokers

Plan-Do-Study-Act PDSA

faculty financial incentive

Epic Tableau dashboard

EHR discrete documentation field

workflow infographic and QI newsletter