Implementation of Smoking Cessation Intervention in General Surgery Clinics

Smoking is associated with increased postoperative complications. Our aim was to evaluate implementation of a virtual tobacco cessation program in two regional general surgery clinics and discern provider and staff perspectives on program barriers and facilitators.

A tobacco treatment registered nurse (TTRN) worked with surgery clinics to create and implement a workflow to engage active smokers in a tobacco cessation program. The program included initial registered nurse intake and referral to Advanced Practice Providers for longitudinal support. Patient engagement across iterations of the program was evaluated, and qualitative evaluation was conducted through focus groups with clinic staff and provider interviews.

The tobacco cessation program was implemented in 3 clinics over 3-19 mo. Patient engagement was higher when the workflow did not rely on clinic staff - either when the TTRN was in-person or when the TTRN made post-visit phone calls. Immediate availability of the TTRN was a strong asset, while patient resistance and work processes were barriers.

Implementation of a virtual TTRN in general surgery clinics yielded low patient engagement in tobacco cessation efforts. Even with workflow-conscious design, additional steps for clinic staff were a barrier and with limited patient acceptance it was not feasible to sustain or consider expanding. Further understanding of the optimal time and method for engaging patients in preoperative smoking cessation is needed.