Sisler Laurel, Omofoye Oluwaseun, Paci Karina, Hadar Eldad, Goldstein Adam O, Ripley-Moffitt Carol
Jt Comm J Qual Patient Saf. 2017 Dec;43(12):633-641. doi: 10.1016/j.jcjq.2017.06.012.
Health care providers routinely undertreat tobacco dependence, indicating a need for innovative ways to increase delivery of evidence-based care. Lean, a set of quality improvement (QI) tools used increasingly in health care, can help streamline processes, create buy-in for use of evidence-based practices, and lead to the identification of solutions on the basis of a problem's root causes. To date, no published research has examined the use of Lean tools in tobacco dependence. A 12-month QI project using Lean tools was conducted to increase delivery of evidence-based tobacco use treatment (TUT) to hospitalized neurosurgical patients.
The study team developed a nicotine replacement therapy (NRT) and counseling protocol for neurosurgery inpatients who indicated current tobacco use and used Lean tools to increase protocol adherence. Rates of NRT prescription, referrals to counseling, and follow-up phone calls were compared pre- and postintervention. Secondary measures included patient satisfaction with intervention, quit rates, and reduction rates at 4 weeks postdischarge.
Referrals to counseling doubled from 31.7% at baseline to 62.0% after implementation of the intervention, and rates of nicotine replacement therapy (NRT) prescriptions during hospitalization and at discharge increased from 15.3% to 28.5% and 9.0% to 19.3%, respectively. Follow-up phone call rates also dramatically increased. The majority of satisfaction survey respondents indicated that counseling had a positive or neutral impact on stress level and overall satisfaction.
Lean tools can dramatically increase use of evidence-based TUT in hospitalized patients. This project is easily replicable by professionals seeking to improve delivery of tobacco treatment. These findings may be particularly helpful to inpatient surgical departments that have traditionally been reticent to prescribe NRT.
医疗服务提供者常常对烟草依赖治疗不足，这表明需要创新方法来增加循证护理的提供。精益管理是一套在医疗保健领域越来越多地使用的质量改进（QI）工具，它可以帮助简化流程，促使人们认可循证实践的使用，并基于问题的根本原因找出解决方案。迄今为止，尚无已发表的研究探讨过精益工具在烟草依赖治疗中的应用。开展了一个为期12个月的使用精益工具的质量改进项目，以增加对住院神经外科患者的循证烟草使用治疗（TUT）。
研究团队为表明当前吸烟的神经外科住院患者制定了尼古丁替代疗法（NRT）和咨询方案，并使用精益工具来提高方案的依从性。比较了干预前后NRT处方率、咨询转诊率和随访电话率。次要指标包括患者对干预的满意度、戒烟率和出院后4周的减少率。
咨询转诊率从基线时的31.7%增加了一倍，在实施干预后达到62.0%，住院期间和出院时的尼古丁替代疗法（NRT）处方率分别从15.3%增加到28.5%和从9.0%增加到19.3%。随访电话率也大幅增加。大多数满意度调查受访者表示，咨询对压力水平和总体满意度有积极或中性影响。
精益工具可以显著增加住院患者对循证烟草使用治疗的使用。该项目很容易被寻求改善烟草治疗提供的专业人员复制。这些发现可能对传统上不愿开具NRT的住院手术科室特别有帮助。
