October 22, 2015

VUMC debuts dedicated tobacco treatment service

Vanderbilt University Medical Center is one of only a few academic medical centers in the country with a dedicated hospital-wide tobacco treatment service.

Vanderbilt’s tobacco treatment service team includes, from left, Rachel Conklin, MMS, Meghan Hayes, MSN, ANP, Miranda Huston, MPH, and Hilary Tindle, M.D., MPH. (photo by Anne Rayner)

Hilary Tindle, M.D., MPH, director of the Vanderbilt Center for Tobacco, Addiction and Lifestyle (ViTAL), rattles off the data without taking a breath: smoking is the leading preventable cause of death in the world; on average 480,000 people die every year from smoking-related diseases; and tobacco use costs the United States $300 billion in health care costs and lost productivity annually.

But the newest bit of information gives her pause.

Vanderbilt University Medical Center (VUMC) is one of only a few academic medical centers in the country with a dedicated hospital-wide tobacco treatment service (TTS).

In a controlled roll out, the TTS recently began seeing patients at the bedside with plans to be hospital-wide within six months, treating an expected 3,500 patients annually.

“We are a new clinical service and our aim is to educate and treat patients for tobacco use. Patients need to understand how smoking impacts their health,” said Tindle. “Often, smoking is directly related to the condition that landed them in the hospital. When patients are hospitalized, talking to them about that link is a real motivator.

“In the past, asking questions about tobacco use has been clinic- and provider-dependent. Now we are standardizing it across the clinic and the hospital.”

According to Tindle, initiating smoking cessation treatment while a patient is hospitalized increases long-term quit rates by 40 percent or higher.

A tobacco treatment service provides evidence-based care to tobacco users who have been identified from the Electronic Health Record (EHR) as a current or former smoker. Certified Tobacco Treatment Specialists proactively visit patients to assess use, patterns and to provide counseling and smoking cessation aids to manage nicotine withdrawal.

In an effort to achieve long-term smoking cessation and extend the care beyond hospitalization, TTS will use an e-referral system, a standardized, efficient technology-based model currently under construction, to connect patients to the Tennessee Quit Line. Quit Lines are active in every state offering free counseling sessions by master’s-level experts and two weeks of medication for smoking cessation.

“We do a good job of managing the care of the patient while they are in the hospital,” Tindle said. “But what happens once they return home and all the familiar triggers come back? They are barraged with all the cues to smoke.

“Smoking or the use of burnt tobacco affects every single organ system in the body. We aim to help any patient quit smoking by using proven therapies.”

Left to their own devices, most patients will not call the Quit Line, said Tindle. She hopes the e-referral will allow patients to become more engaged in quit efforts.

Vanderbilt’s electronic health record is certified for Meaningful Use, which allows for the template to serve as a communication tool between providers. TTS has harnessed this standard technology for e-referral, allowing patient information

to be sent securely to the Quit Line. Quit Line experts will then contact patients for continued smoking cessation assistance.

“Treating tobacco use is not easy,” Tindle said. “It requires an organized effort. The health care system has not been maximally mobilized toward this effort until now. We knew that tobacco treatment was important, but the systems were not in place to deliver it.

“Now we are seeing a change. We are gaining more traction and implementing programs,” she said. “At Vanderbilt, our program is very organic and grass roots. Our team goes room to room, person to person.”

Tindle applauds Vanderbilt’s proactive move to create a dedicated tobacco treatment program. She said Vanderbilt’s program is different for a couple of reasons.

“First, we have a nurse practitioner and a physician assistant who can prescribe the FDA-approved medications,” Tindle said. “We stand a better chance of linking our patients with proven treatments when we can prescribe for them.

“Second, the e-referral is our chance to offer high value, efficient, standardized care that extends beyond hospitalization and makes use of existing Quit Lines, which are underutilized.”

Plans call for the program to expand to other inpatient areas as well as branch into other sectors of the hospital, including pre-operative care, procedural suites and the Emergency Department. Tindle is also working with leaders in Psychiatry to augment treatment of smoking in the Vanderbilt Psychiatric Hospital.

The TTS team consists of Meghan Hayes, MSN, ANP-BC, associate in Nursing, Rachel Conklin, MMS, associate in Nursing, and Miranda Huston, MPH, M.S., a health educator.