Collaboration to reduce smoking in targeted groups

Overview

As part of the development of the Secondary Care Programme in Newcastle upon Tyne, the aim of the collaborative was to bring systems together (acute, primary and public health) to benefit targeted communities and groups in the city.  Working initially with peri-operative consultants the protocol went ‘live’ in May 2016 but has since been rolled out to a further 14 departments (including dental clinics), well beyond ‘Stop before the Op’ departments.  Referrals from hospital departments are flowing through into the service each month.  The targeted groups included patients who access hospital services pre-operatively, post-operatively or speciality clinics.

The protocol provides wider access for communities to benefit from stop smoking services (SSS)

The Case for Change

Evidence suggests that this is an area where the ‘inverse care’ law applies and those in greatest need are least likely to receive beneficial services. Widening access to targeted groups of patients is a priority for Newcastle upon Tyne. Previously, whilst signposting took place with hospital departments, the arrangement was not strong enough to ensure patients got the best support available to them.

Overview of Innovation

The change has been to establish a robust protocol, one contact point for every patient across the region.  This has involved working with the different departments to account for the various entry points as patients access hospital services, pre-operatively, post-operatively or speciality clinics.  It is about utilising SSS in the community to support patients; it does not address inpatient stays.  The change in practice is that clinicians in many departments within the hospital are enabled to directly refer patients into Stop Smoking Services.  Newcastle upon Tyne acts as a hub service where any patient can be referred either locally or further afield to regional colleagues for stop smoking advice and support.

Progress to Date

A ‘one step’ referral has been set up which takes every referral from the Freeman and RVI hospitals.  The service acts as a regional hub and ensures that any ‘out of area’ patient referrals go directly to the relevant service for them to engage with the patient nearer to where they live. Work to implement the protocol is underway with many departments; ‘going live’ dates are staggered as departments incorporate the protocol into their own procedures.

Protocol is now live in the following departments:

Pre-operative assessment clinics

Liver Transplant (non alcohol)

Periodontal patient study

Main Outpatients RVI & Main Outpatients Freeman

  • General medicine
  • General surgery
  • Cardio/Thoracic Medicine
  • Renal
  • Urology

Mental Health Trust – NTW

Cancer Clinical (encompassing lung, upper GI, dermatology) (Specialist Nurses)

Maternity – Improving infant and maternal outcomes (reducing smoking in pregnancy)

Respiratory – Ward 29 at Freeman

Great North Children’s Hospital

Newcastle Dental Hospital (8 daily clinics)

Asthma Clinic

Rheumatology (work underway)

COPD – e-cigarette study

COPD – Unplanned Admissions

COPD – GP Practices (case finding)

NTW – upon discharge

Mental Health Voluntary Sector Providers (3 in Newcastle)

Cardiac – pre-admission & post-surgery

Musculoskeletal / pain

Impact

The project is still only in the first year of implementation, having started with pre-operative patients in May 2016. There is currently an increased flow of patients into the Stop Smoking Service and an increased number of hospital departments who want their patients supported to stop smoking. The aim is to write up the initiative and regularly report back to participating departments.  Initial results show there has been 120 referrals including 2 female chronic smokers (COPD sufferers) who have been successful in quitting smoking and went on to have their planned surgery.

Next Steps and Plans for the Future

  • Increase the number of patients accessing Stop Smoking Services in the community, opening up access beyond patients going through surgical procedures;
  • Put into place a new protocol which will encompass Activity for Health as well as Stop Smoking Services.

Contact

For further details of the AHSN Respiratory programme please contact: Sue Hart, Respiratory Programme Lead, AHSN NENC sue.hart@ahsn-nenc.org.uk.

For further details on the initiative in Newcastle upon Tyne please contact: Lynda Seery. Public Health Specialist, lynda.seery@newcastle.gov.uk

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