Implementing a smoke-free medical campus: impact on inpatient and employee outcomes

Hospitals fear that transitioning to a smoke-free medical campus will decrease patient volume, particularly for patients who smoke. When our hospital campus, a 180-bed acute care facility located in a small town, implemented the smoke-free medical campus on July 1, 2006, we prospectively monitored inpatient and employee outcomes.

Inpatient volume, percentage of inpatients who currently smoke, nicotine replacement therapy (NRT) orders (obtained from electronic medical records), the number of inpatients who signed out against medical advice (obtained from incident reports), and employee tobacco-use rates from annual occupational health assessments were compared pre-ban and post-ban.

The monthly average for the percentage of inpatients who currently smoke has been steady, at 20% to 22% post-ban. NRT orders tripled after the ban. There was no significant change in the rate of inpatients who signed out against medical advice pre-ban and post-ban. During the year preceding the ban, 150 employees participated in a cessation program offered by Employee Health. The pre-ban employee self-reported smoking rate for the same 4-month period (March-June) was 14.3% in 2005, 14.8% in 2006, and 9% in 2007 (P < 0.0002).

Implementing a smoke-free medical campus did not adversely affect inpatient volume (even among smokers), significantly increased inpatient NRT use, and decreased hospital employee smoking rates.