What’s New in the Patient Safety World

December 2012

Just Went to Have a Smoke…



Recently we went to see Denzel Washington’s new movie “Flight”. In one scene there are 3 hospital inpatients who happen to come to the same hospital stairwell to smoke. One is a trauma patient, another an oncology patient, and the other a substance abuse patient recovering from an overdose. We wondered how often that scene might actually take place. To our amazement the same week a study came out in the Archives of Internal Medicine (Regan 2012) that answered our question! The answer: 18.4% of patients who smoke will smoke at some time during their inpatient hospitalization!


Smoking craving, rather than the number of cigarettes previously smoked per day, was a big risk factor for smoking while hospitalized.


Desire to smoke is a well-known risk factor for patients leaving emergency departments without being seen or for leaving against medical advice. We also suspect it is a risk factor for elopement from behavioral health units even though that has received little attention in the literature. Patient smoking is obviously also a risk factor for hospital fires, increases the MI risk, increases pulmonary complications, and impairs wound healing among other adverse effects.


One message in the Regan study is clear: just assessing tobacco cessation issues and offering nicotine replacement therapy and counseling on admission is not enough. Ordering nicotine replacement therapy on the day of admission was associated with less smoking before the counselor’s visit but not for the entire hospital stay. So it is really incumbent upon hospitals to incorporate continued assessment, perhaps even daily, of tobacco issues into their care plans.






Regan S, Viana JC, Reyen M, Rigotti NA. Prevalence and Predictors of Smoking by Inpatients During a Hospital Stay. Arch Intern Med 2012; ():1-5, Published online ahead of print November 5, 2012




Schroeder SA. Smoking Among Hospitalized PatientsComment on “Prevalence and Predictors of Smoking by Inpatients During a Hospital Stay” Arch Intern Med 2012; (): 1-2 published online November 5, 2012






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