Encouraging cessation and providing referrals to cessation treatment programs is an important aspect of high-quality cancer care for patients who smoke tobacco. The UMMC outpatient cancer care clinics did not have a highly reliable process for providing smoking cessation resources to identified tobacco smokers, and the baseline rate of referrals was 12% in calendar year 2022. Following our implementation of a hardwired Epic process to connect positive smoking screens with pended provider orders, our clinics were able to significantly increase the referral rate.
Problem:Increase the rate of referral of adult tobacco smokers from outpatient cancer treatment clinics to tobacco cessation programs.
Measurement: Control charts, run charts
Analysis: Reports were developed to collect the screening and referral data, which was also visualized as run charts. The team performed a gap analysis and generated ideas for solutions. We used the Ottowa Model for Smoking Cessation as our model for an effective solution.
Implementation: We leveraged EPic and built a BPA and smartest that now pop up for MAs to pend orders for signature. Pended orders provide a real-time conversation prompt for physician/APP to encourage patients to quit, and expedites placement of referral orders. Referral programs are electronically notified and contact the patient.
Results/Discussion: Referral rate improved from 12% to 57% in the first three months following go live. Hardwiring the solution into Epic was key for this improvement. We will sustain and improve by using our detailed reports to tract individual performance and providing one-on-one follow up for non-compliance.
