Abstract Details

Title Development and Implementation of an Inpatient Smoking Cessation Counseling Pathway for Stroke Patients: A Quality Improvement Study

Topic Neurohospitalist

Presentation(s) S36 - Neurohospitalist (12:03 PM-12:15 PM)

Poster/Presentation
Number 005

Objective

We aimed to evaluate and improve the consistency of our smoking cessation counselling (SCC) on our stroke unit and assess its efficacy.

Background Smoking is a major modifiable risk factor for recurrent stroke, yet inpatient SCC is inconsistently delivered. We designed, implemented, and evaluated a standardized inpatient SCC pathway on a tertiary stroke unit.

Design/Methods We conducted a three-phase, pre–post quality improvement (QI) initiative: Phase 1-quantify the current SCC gap; Phase 2-develop a consensus pathway using the 5A model (Ask, Advise, Assess, Assist, Arrange), using electronic medical record tools, and guided by modified Delphi consensus among multidisciplinary stakeholders on our stroke service; and Phase 3-Evaluate counseling delivery and short-term smoking outcomes via chart review and 90-day telephone surveys. Adults with ischemic stroke/transient ischemic attack (TIA) who smoked at admission were eligible. Primary outcome measure was the delivery of SCC during hospital admission for stroke. Secondary outcome measures included reduction in cigarettes/day and self-reported cessation at telephone follow up.

Results

Phase 1 care gap quantification showed 28% (n=14/50) SCC delivery 2022. Phase 3 post-implementation of our pathway, SCC delivery increased to 81% (51/63, p<.001). There was no difference in mean reduction in cigarettes/day between counseled vs non-counseled patients (10.6 vs 9.6, p=.741) nor smoking cessation rates (p=.951).

Conclusions

A consensus-built, SCC pathway markedly increased counseling delivery but did not improve short-term cessation patient outcomes or process measures. Future iterations could bundle bedside pharmacotherapy, automated referrals, and translate process gains into patient-level benefit.

Authors/Disclosures
Arth Pahwa, MD, MBA (Arth Pahwa) PRESENTER	Dr. Pahwa has nothing to disclose.
Gurpreet Chaggar, MD	Dr. Chaggar has nothing to disclose.
Mahesh Kate, MD (Alberta Health Services)	Dr. Kate has nothing to disclose.

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